Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

Abstract Background Episiotomy in Mexico is highly prevalent and often routine - performed up to 95% of births primiparous women. The WHO suggests that episiotomy be used selective cases, with an expected prevalence 15%. Training programs date have been unsuccessful changing this practice. This research aims understand how why practice persists despite shifts knowledge attitudes facilitated by the implementation obstetric training program. Methods a descriptive interpretative qualitative study. We conducted 53 pre post-intervention (PRONTO© Program) semi-structured interviews general physician, gynecologists nurses ( N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software iteratively organize codes. Through interpretive triangulation, team found theoretical saturation explanatory depth on key analytical categories. Results Themes fell into five major themes surrounding their perceptions episiotomy: as preventive measure, procedure resolves problems moment, gives clinician control, risky practice, role social norms practicing it. show contradictory discourses among professionals. Despite growing support for use episiotomy, it remains positively perceived effective prophylaxis complications childbirth while maintaining control hands health care providers. Conclusions Perceptions shed light persists, provides insight multi-faceted approaches will required affect harmful obstetrical