Episiotomy knowledge, attitudes and practice: a cross- sectional survey of four public Israeli hospitals and review of the literature

Background. National episiotomy guidelines state that restricted use is preferable, but the indications for this selective performance are not firmly defined, and the benefits are not clearly determined. Objective. To examine the attitudes of Israeli midwives and doctors towards episiotomy use and to review these in light of the relevant professional literature. Methods. Using anonymous questionnaires, a survey was conducted among midwives and obstetricians in four northern Israel hospitals over a one-year period. In addition to providing demographic and professional data, the accoucheurs were asked to score their agreement with 11 proposed statements regarding episiotomy practice. Results. Overall, 32 midwives and 84 obstetricians completed the questionnaires. Significantly more obstetricians considered episiotomy beneficial in prevention of obstetric anal sphincter injuries and pelvic floor damage (29.1% versus 9.4%, p=0.028, and 19% versus 3.1%, p=0.036, respectively), while more midwives compared to obstetricians believed that national guidelines provide precise definitions regarding episiotomy use (46.9% versus 15%, p=0.001). All of the less experienced accoucheurs (less than 15 years experience) believed there was a need to change the policy regarding episiotomy performance, compared to only 15.6% of their more experienced colleagues (p=0.002). Ethical approval was not required, as the study was conducted with health personnel. Implications. This study demonstrates the accoucheurs lacked awareness of the existing evidence and national guidelines regarding episiotomy use. Moreover, the literature review highlighted the suboptimal quality of the available evidence. Therefore, uniform protocols, educational programmes and further high-quality research are essential to guide episiotomy practice.