Evaluation of evidence based episiotomy practice by the midwives at Pumwani maternity hospital labour ward, Nairobi
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Research based practice in nursing and midwifery is regarded as a means of ensuring that quality care is provided by integrating individual clinical expertise with the best available external clinical evidence from systematic research. There is an increasing pressure on healthcare professionals to ensure that their practice is based on evidence from good quality research. Becoming abreast with the current evidence based information is not enough if the information is not translated into clinical practices. This study was to establish the midwives’ level of evidence based information and how much of it is being applied into the clinical practice. Evidence based episiotomy practice by the midwives in Pumwani Maternity hospital (PMH) was evaluated using cross-sectional qualitative and quantitative descriptive statistical methods. The study population consisted of fifty eight midwives working in the labour ward; only thirty five appropriately completed questionnaires were analyzed. The focus group discussion and the key informants gave their in-depth views and information during the interview on the study subject. Purposive sampling was used to select the midwives who met the inclusion criteria. Data cleaning was done by ensuring the completeness and consistency of responses in the study tools. Quantitative data analyzed using content analysis and processed according to themes using Statistical Package for the Social Sciences version 16. Quantitative data analysis was done by using inferential and descriptive statistics. Correlation coefficient and CHI square was employed to bring out the relationships among variables. The study sample included 45 midwives which revealed that 46% of the midwives obtained the evidence based practice information on episiotomy through continuing education and personal efforts. The midwives perform an assessment on the patient before giving an episiotomy and different criteria influence their decision to perform an episiotomy. The most prevalent type of episiotomy preferred by the midwives was medio-lateral (86%) unlike the mid-line. These criteria are not exclusively evidence based. The proportions of midwives based their practices on the following criteria: very tight perineum (17%), breech presentation (13%), premature labour (12%), FGM (10%), instrumental delivery (5%), status of the foetus (9%), and (29%) others (big baby, mothers serological status, shoulder dystocia and poor maternal efforts). Despite the prevalence of HIV/AIDS among the patient population, episiotomy is still performed under unavoidable circumstance. The respondents stated actual and potential barriers to implementation of evidence based practice (EBP) of episiotomy which included lack of specific guidelines on specific procedures, workload due to high patient population, inadequate administration support, poor accessibility of research reports and personal attitudes. It is evident from the findings that a higher percentage (49%) of midwives rated their knowledge on evidence based episiotomy practice on high level (4-5 points) but the actual practice did not correspond to the application of the knowledge. The study recommends an urgent need for the PMH to put in place modalities to ensure that practice guidelines are developed, used and reviewed appropriately to ensure standardized services especially in an institution which trains the midwifery students.