Episiotomy at a university hospital in Lebanon : practice and physicians’ perceptions -

Abstract

Episiotomy is a surgical procedure performed during labor and delivery that is thought to facilitate childbirth. Several international organizations around the world have issued recommendations to regulate this practice. In Lebanon, there has never been a study which analyzed medical health records in order to understand this practice in the country.This thesis is based on a retrospective analysis of hospital records in a university hospital over 5 years in addition to interviews with Obstetrician-Gynecologists in order to understand their perceptions of the practice. Through our analysis and our interviews, I was able to identify several risk factors for episiotomy. These were: parity, maternal age, and fetal weight. I was also able to conclude that women who had an episiotomy had a higher percentage of high degree perineal tears when compared to women without an episiotomy. In addition, through our interviews, I was able to note discrepancies between senior physicians’ approach and junior physicians’ approach. The latter seemed to be more in favor of a restrictive approach towards episiotomy rather than a routine one. In addition, junior physicians seemed to be more appreciative of implementing guidelines and policies to guide the practice.In conclusion, this study is the first of its kind in the country. It was able to show that the university hospital is still behind in terms of approaching the WHO recommended rates of episiotomy and that episiotomy is not preventing 3rd and 4th degree lacerations. Thus this finding should be used to discourage performing prophylactic episiotomies. I hope that by adopting policies that guide the practice in the university hospital this could set the example for other hospitals in Lebanon and thus encourage a new approach on the issue at the level of the Ministry of Public Health. More studies on episiotomy in Lebanon are needed that could potentially look at rates in different hospitals and medical care centers and also examine other complications that could ar