title: The correct episiotomy: does it exist? A cross-sectional survey of four public Israeli hospitals and review of the literature.
abstract: OBJECTIVE
  Our objective was to assess episiotomy technique used in Israeli hospitals, to determine factors influencing incision parameters, and to review relevant up-to-date professional literature.
  
  
  METHODS
  Using anonymous questionnaires, a survey was conducted among obstetricians and midwives in the four public hospitals in northern Israel over a 1-year period commencing in October 2013. In addition to demographic and professional data, the accoucheurs were asked to describe the technique they usually use to perform an episiotomy (length, angle, and distance of initiation point from midperineum).
  
  
  RESULTS
  Overall, 84 obstetricians and 32 midwives participated in the survey. Only 37.6% reported performing a mediolateral episiotomy, while the rest described the lateral type, placing the initiation point at an average distance of 2.45 ± 0.88 cm from the fourchette. Compared with midwives, obstetricians reported performing a significantly longer episiotomy (3.53 ± 1.01 vs. 2.73 ± 0.81 cm, p = 0.0002).
  
  
  CONCLUSIONS
  According to our study and relevant literature review, the technique of episiotomy varies significantly between health professionals and is not uniformly congruent with international practice guidelines. In part, this is derived from unclear literature evidence and lack of consensus definition for proper technique of this procedure by the national guidelines. Thus, further higher-quality research, uniform protocols, and educational programs are needed to guide episiotomy practice.
authors.affiliation: Department of Obstetrics and Gynecology, Carmel Medical Center, 7 Michal St., Haifa, Israel, lena2303@gmail.com.
authors.forename: Lena
authors.initials: L
authors.lastname: Sagi-Dain
authors.forename: Shlomi
authors.initials: S
authors.lastname: Sagi
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004841:Episiotomy / Q000193:education / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006779:Hospitals, Public; D006801:Humans; D057226:Information Seeking Behavior; D007557:Israel; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000379:methods*; D009774:Obstetrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
references.citation: BJOG. 2005 Aug;112(8):1156-8
references.pmid: 16045535
references.citation: Int Urogynecol J. 2015 Feb;26(2):235-42
references.pmid: 25227745
references.citation: Med Devices (Auckl). 2014 Jul 31;7:253-6
references.pmid: 25114598
references.citation: Int J Gynaecol Obstet. 2010 Feb;108(2):97-100
references.pmid: 19922933
references.citation: Birth. 2006 Jun;33(2):117-22
references.pmid: 16732776
references.citation: J Obstet Gynaecol Res. 2014 Jul;40(7):1877-82
references.pmid: 25056465
references.citation: Med Devices (Auckl). 2014 Feb 21;7:23-8
references.pmid: 24570598
references.citation: BJOG. 2012 Apr;119(5):522-6
references.pmid: 22304364
references.citation: Int J Gynaecol Obstet. 2008 Oct;103(1):5-8
references.pmid: 18674760
references.citation: Int J Gynaecol Obstet. 2011 Mar;112(3):220-4
references.pmid: 21247571
references.citation: Obstet Gynecol. 2006 Apr;107(4):957-62
references.pmid: 16582142
references.citation: Am J Obstet Gynecol. 1976 Mar 15;124(6):656
references.pmid: 769557
references.citation: Int J Gynaecol Obstet. 2014 Jan;124(1):72-6
references.pmid: 24112747
references.citation: Int Urogynecol J. 2013 May;24(5):865-72
references.pmid: 23108732
references.citation: BJOG. 2012 May;119(6):724-30
references.pmid: 22390647
references.citation: Birth. 2012 Sep;39(3):203-10
references.pmid: 23281902
references.citation: Int J Gynaecol Obstet. 2008 Feb;100(2):188-9
references.pmid: 17920602
references.citation: Eur J Obstet Gynecol Reprod Biol. 2014 Mar;174:46-50
references.pmid: 24388846
references.citation: Birth. 2013 Dec;40(4):247-55
references.pmid: 24344705
references.citation: Int Urogynecol J. 2014 Dec;25(12):1629-37
references.pmid: 24807426
references.citation: Saudi Med J. 2010 Jul;31(7):764-7
references.pmid: 20635009
references.citation: BJOG. 2003 Dec;110(12):1041-4
references.pmid: 14664873
references.citation: BJOG. 2012 Aug;119(9):1147; author reply 1148-9
references.pmid: 22780819
references.citation: BJOG. 2006 Feb;113(2):190-4
references.pmid: 16411997