title: Midwives' Clinical Reasons for Performing Episiotomies in the Kurdistan Region: Are they evidence-based?
abstract: OBJECTIVE
  An episiotomy is one of the most common obstetric surgical procedures and is performed mainly by midwives. The decision to perform an episiotomy depends on related clinical factors. This study aimed to find out midwives' reasons for performing episiotomies and to identify the relationship between these reasons and the demographic characteristics of the midwives.
  
  
  METHODS
  This cross-sectional study was conducted between 1(st) July and 30(th) September 2013 in three governmental maternity teaching hospitals in the three main cities of the Kurdistan Region of Iraq. All of the midwives who had worked in the delivery rooms of these hospitals for at least one year were invited to participate in the study (n = 53). Data were collected through interviews with midwives as well as via a questionnaire constructed for the purpose of the study. The questionnaire sought to determine: midwives' demographic characteristics; type of episiotomy performed; authority of the decision to perform the procedure, and reasons for performing episiotomies.
  
  
  RESULTS
  THE MAIN CLINICAL REASONS REPORTED BY MIDWIVES FOR PERFORMING AN EPISIOTOMY WERE: macrosomia/large fetus (38, 71.7%), breech delivery (31, 58.5%), shoulder dystocia (29, 54.7%), anticipated perineal tear (27, 50.9%) and fetal distress (27, 50.9%). There was a significant association between the frequency of these reasons and midwives' total experience in delivery rooms as well as their levels of education.
  
  
  CONCLUSIONS
  Most of the reasons given by the midwives for performing episiotomies were not evidence-based. Age, years of experience, specialties and level of education also had an effect on midwives' reasons for performing episiotomies.
authors.affiliation: Maternity Nursing Unit, College of Nursing, Hawler Medical University, Erbil, Iraq.
authors.forename: Hamdia M
authors.initials: HM
authors.lastname: Ahmed
keywords: Episiotomy; Iraq; Midwives; Nurses
references.citation: Ceska Gynekol. 2011 Oct;76(5):378-85
references.pmid: 22132640
references.citation: Midwifery. 2013 Aug;29(8):943-9
references.pmid: 23453700
references.citation: Obstet Gynecol. 2000 Aug;96(2):214-8
references.pmid: 10908765
references.citation: Midwives. 2012;15(5):34-5
references.pmid: 24873050
references.citation: Arch Gynecol Obstet. 2013 Dec;288(6):1249-56
references.pmid: 23708390
references.citation: J Res Med Sci. 2011 Dec;16(12):1583-9
references.pmid: 22973367
references.citation: BMJ. 1998 Apr 18;316(7139):1179-80
references.pmid: 9552989
references.citation: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000081
references.pmid: 19160176
references.citation: Midwifery. 2011 Aug;27(4):399-408
references.pmid: 21601321
references.citation: J Gynecol Obstet Biol Reprod (Paris). 2006 Feb;35(1 Suppl):1S24-1S31
references.pmid: 16495824
references.citation: Ann Surg. 2008 Feb;247(2):224-37
references.pmid: 18216527
references.citation: Reprod Health. 2007 Oct 29;4:10
references.pmid: 17967168
references.citation: Iran J Nurs Midwifery Res. 2013 May;18(3):237-45
references.pmid: 23983762