title: Influence of training in the use and generation of evidence on episiotomy practice and perineal trauma.
abstract: OBJECTIVE
  To examine episiotomy practices before and after a multi-component intervention designed to support the use and generation of research evidence in maternal and neonatal health care.
  
  
  METHODS
  Set in 9 centers across 4 Southeast Asian countries, a retrospective survey was performed for 12 recommended pregnancy/childbirth practices and 13 outcomes of women in each center before and after intervention. Qualitative interviews were conducted to assess staff awareness and experience in evidence-based practice.
  
  
  RESULTS
  There were significant decreases in the rate of episiotomy, from 64.1% to 60.1% (risk difference [RD] -4.0; 95% confidence interval [CI], -5.8 to -2.2) for all women and from 92.2% to 80.7% (RD -11.5; 95% CI, -13.4 to -9.6) for nulliparous women. Severe trauma decreased from 3.9% to 1.9% (RD -2.0; 95% CI, -2.7 to -1.4) for all women and from 6.7% to 3.0% (RD -3.7; 95% CI, -4.9 to -2.5) for nulliparous women. The frequency of intact perineum increased from 12.4% to 15.6% (RD 3.2; 95% CI, 1.9-4.6) for all women and from 1.7% to 8.0% (RD 6.3; 95% CI, 5.0-7.5) for nulliparous women.
  
  
  CONCLUSIONS
  An intervention based on understanding and using the best available evidence can result in significant improvements in care and health outcomes.
authors.affiliation: Department of Paediatrics, Penang Medical College, Penang, Malaysia. jho@pc.jaring.my
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Ho
authors.forename: Porjai
authors.initials: P
authors.lastname: Pattanittum
authors.forename: Robert P
authors.initials: RP
authors.lastname: Japaraj
authors.forename: Tari
authors.initials: T
authors.lastname: Turner
authors.forename: Ussanee
authors.initials: U
authors.lastname: Swadpanich
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Crowther
mesh_terms: D000328:Adult; D004841:Episiotomy / Q000193:education* / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015337:Multicenter Studies as Topic; D010298:Parity; D036801:Parturition; D010502:Perineum / Q000293:injuries* / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult