Changing minds: The impact of introducing evidence-based practices around the use of episiotomy in a South Indian Tertiary Centre
CONCLUSION: Successful institution of any change in behavior needs an understanding of the perception and attitude towards the change. A focus on respectful maternity care, hospital policies based on scientific evidence and an enabling environment for training and education can avoid unnecessary birth practices not recommended for healthy pregnant women.PMID:37801839 | DOI:10.1016/j.midw.2023.103833 (Source: Midwifery)
Source: Midwifery - October 6, 2023 Category: Midwifery Authors: Maimoona Ahmed Inderjeet Kaur Sowmya Thota Source Type: research
Obstetric Violence is a Misnomer
The term “obstetric violence” has been used in the legislative language of several countries with the intention of protecting mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures such as induction of labor, episiotomy, and cesarean delivery and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from...
Source: American Journal of Obstetrics and Gynecology - October 5, 2023 Category: OBGYN Authors: Frank A. CHERVENAK, Renee MCLEOD-SORDJAN, Susan L. POLLET, Monique DE FOUR JONES, Mollie R. GORDON, Adriann COMBS, Eran BORNSTEIN, Dawnette LEWIS, Adi KATZ, Ashley WARMAN, Amos GR ÜNEBAUM Source Type: research
Perineal resuturing versus conservative treatment for dehisced perineal wounds and episiotomies: a systematic review and meta-analysis
ConclusionWe found no significant differences in the healing time between the resuturing group and the conservative treatment group. However, the sample sizes of the studies were small. A well-designed, large, and prospective randomized controlled trial is needed to evaluate the optimal treatment modality for dehisced perineal wounds. (Source: International Urogynecology Journal and Pelvic Floor Dysfunction)
Source: International Urogynecology Journal and Pelvic Floor Dysfunction - September 23, 2023 Category: OBGYN Source Type: research
Evaluation of levator ani muscle elasticity after vaginal delivery and cesarean section using shear wave elastography
ConclusionLAM elasticity was significantly lower after vaginal delivery than after cesarean delivery. Furthermore, the elasticity of the right LAM was lower after operative vaginal delivery than after normal vaginal delivery. SWE has the potential to provide an objective quantitative assessment of postpartum pelvic floor muscle recovery. (Source: Journal of Medical Ultrasonics)
Source: Journal of Medical Ultrasonics - September 23, 2023 Category: Radiology Source Type: research
Perineal resuturing versus conservative treatment for dehisced perineal wounds and episiotomies: a systematic review and meta-analysis
ConclusionWe found no significant differences in the healing time between the resuturing group and the conservative treatment group. However, the sample sizes of the studies were small. A well-designed, large, and prospective randomized controlled trial is needed to evaluate the optimal treatment modality for dehisced perineal wounds. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - September 23, 2023 Category: OBGYN Source Type: research
A systematic review and meta-synthesis of qualitative studies on childbirth perineal trauma for the development of a Core Outcome Set
About 85% of women who have a vaginal birth sustain some degree of perineal trauma [1]. Maternal injury during vaginal childbirth refers to any form of physical trauma [2]. Such injuries may have an impact on the relevant anatomical tissues and structures such as the perineal muscles, genitalia, external and internal anal sphincters, or rectal wall [2]. Injuries can occur either spontaneously or iatrogenically, via episiotomy or perineotomy. According to the perineal injury classification published by the Royal College of Obstetricians and Gynaecologists (RCOG), the International Continence Society (ICS) and the Internatio...
Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology - September 11, 2023 Category: OBGYN Authors: Maria Patricia Roman, Shaurya Aggarwal, Stergios K Doumouchtsis Tags: Review article Source Type: research
The relationship between perineal trauma and postpartum psychological outcomes: a secondary analysis of a population-based survey
This study aimed to determine the associations between... (Source: BMC Pregnancy and Childbirth)
Source: BMC Pregnancy and Childbirth - September 6, 2023 Category: OBGYN Authors: Charles Opondo, Si ân Harrison, Julia Sanders, Maria A. Quigley and Fiona Alderdice Tags: Research Source Type: research
Episiotomy practice in France and prevention of high-grade perineal tears at the time of operative vaginal delivery: a prospective multicentre ancillary cohort study
ConclusionsThis study did not demonstrate a significant reduction in risk for OASI at the time of OVD when the episiotomy suture angle was >45 ° from the median line. However, these results should be interpreted with caution owing to the low prevalence of OASIs in our cohort. (Source: International Urogynecology Journal and Pelvic Floor Dysfunction)
Source: International Urogynecology Journal and Pelvic Floor Dysfunction - September 1, 2023 Category: OBGYN Source Type: research
The ethics of consent during labour and birth: episiotomies
Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. We then discuss challenges and opportunities fo...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: van der Pijl, M., Verhoeven, C., Hollander, M., de Jonge, A., Kingma, E. Tags: Open access Feature article Source Type: research
Consent and the problem of epistemic injustice in obstetric care
An episiotomy is ‘an intrapartum procedure that involves an incision to enlarge the vaginal orifice,’1 and is primarily justified as a way to prevent higher degrees of perineal trauma or to facilitate a faster birth in cases of suspected fetal distress. Yet the effectiveness of episiotomies is controversial, and many professional bodies recommend against the routine use of episiotomies. In any case, unconsented episiotomies are alarmingly common, and some care providers in obstetric settings often fail to see consent as necessary in context. In their article, ‘The ethics of consent during labour and birth...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Lee, J. Y. Tags: Commentary Source Type: research
Capacity assessment during labour and the role of opt-out consent
The authors of the feature article argue against implied consent in all episiotomy cases, but allow that opt-out consent might be appropriate in limited circumstances.1 However, they do not indicate how clinicians should assess whether the pregnant person is capable of consenting in this way during an obstetric emergency. This commentary will focus on how capacity should be determined during these circumstances, suggest next steps for clinicians if capacity is deemed uncertain or absent, and discuss the appropriate role for opt-out consent in labour. Previous studies investigating the extent to which pregnant persons retai...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Mumford, K. Tags: Commentary Source Type: research
Episiotomies and the ethics of consent during labour and birth: thinking beyond the existing consent framework
We agree with van der Pijl et al that the question of how to ensure consent is obtained for procedures which occur during labour and childbirth is vitally important, and worthy of greater attention.1 However, we argue that the modified opt-out approach to consent outlined in their paper may not do enough to protect the choice and agency of birthing people. Moreover, while their approach reflects a pragmatic attempt to facilitate legal clarity and certainty in this context, this is not necessarily responsive to the messy realities of decision-making during labour (and beyond). We outline some of our concerns with their prop...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Nelson, A., Clough, B. Tags: Commentary Source Type: research
Birth, trust and consent: reasonable mistrust and trauma-informed remedies
In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour and beyond pregnancy-related care. One feature of their model for adequate informed consent is trust in the syste...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Lanphier, E., Lomotey-Nakon, L. Tags: Commentary Source Type: research
Extending the ethics of episiotomy to vaginal examination: no place for opt-out consent
van der Pijl et al1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation to VE; and third, the significant risk of perpet...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Brione, R. Tags: Commentary Source Type: research
