Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia.
First documented in 1741, the practice of episiotomy substantially increased worldwide during the 20th century. However, research shows that episiotomy is not effective in reducing severe perineal trauma and may be harmful. Using a mixed-methods approach, we conducted a study in 2013-14 on why obstetricians and midwives in a large maternity hospital in Phnom Penh, Cambodia, still do routine episiotomies. The study included the extent of the practice, based on medical records; a retrospective analysis of the delivery notes of a random sample of 365 patients; and 22 in-depth interviews with obstetricians, midwives and recently delivered women. Of the 365 women, 345 (94.5%, 95% CI: 91.7-96.6) had had an episiotomy. Univariate analysis showed that nulliparous women underwent episiotomy more frequently than multiparous women (OR 7.1, 95% CI 2.0-24.7). The reasons given for this practice by midwives and obstetricians were: fear of perineal tears, the strong belief that Asian women have a shorter and harder perineum than others, lack of time in overcrowded delivery rooms, and the belief that Cambodian women would be able to have a tighter and prettier vagina through this practice. A restrictive episiotomy policy and information for pregnant women about birthing practices through antenatal classes should be implemented as soon as possible.
Centre Population & Développement (CEPED)-UMR 196: IRD (Institut de Recherche pour le Développement) and Université Paris Descartes, Paris, France. Electronic address: clemschantz@hotmail.com.
Clémence
C
Schantz
Calmette Maternity Hospital, Phnom Penh, Cambodia.
Kruy Leang
KL
Sim
Calmette Maternity Hospital, Phnom Penh, Cambodia.
Ek Meng
EM
Ly
ANRS (Agence Nationale de Recherche sur le VIH et les Hépatites), and Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Isped (Institut de Santé Publique d'Epidémiologie et de Développement), Centre INSERM (Institut National de la Santé et de la Recherche Médicale) U897-Epidemiologie-Biostatistique, Université de Bordeaux, Bordeaux, France.
Hubert
H
Barennes
Calmette Maternity Hospital, Phnom Penh, Cambodia.
So
S
Sudaroth
Independent Researcher, Annecy le Vieux, France.
Sophie
S
Goyet
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002160:Cambodia; D004841:Episiotomy / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006771:Hospitals, Maternity; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008875:Middle Aged; D008880:Midwifery; D009035:Mothers / Q000523:psychology; D010298:Parity; D010502:Perineum; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D055815:Young Adult
Cambodia; delivery; episiotomy; over-medicalization; pregnancy; quality of care