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1. INTRODUCTION
Role of Midwives & Their Attitudes
Role of Midwives & Their Attitudes, A midwife’s role during delivery is to manage the perineum of the woman and reduce trauma following the birth of the newborn, but despite the caring nature of their role, they seem to be afraid of performing surgical procedures like episiotomies and mostly avoid recognising the need for it. This reality owes its existence to many facts like the experience bracket of a midwife, her level of grooming and training, exposure to procedures and its frequency, ignorance of modern techniques and studies, fear of endangering the life of the mother etc.
1.1 The History and Evolution of Episiotomy:
The first episiotomy was reportedly performed in 1741 (Labor & Birth, 2012) as prevention against severe perineal tears. Thereafter, it gradually gained popularity amongst male birth attendants. Sir Fielding Ould (1741) is closely associated with it as the first obstetrician to describe it in his ‘Treatise of Midwifery in Three Parts’, as he explained the circumstances under which the labor is prolonged and also suggested remedial procedures (Bartscht and Delancey, n.d.).
Episiotomies were increasingly performed in the early 1900’s, when the place of childbirth shifted gradually from homes to hospitals (Repke, 2003).
This also resulted into a growing involvement of physicians in the normal and uncomplicated birth process, which was previously the domain of midwives. The procedure soon became popular and was being widely used but within the last 15 years or so, intensified research has been carried out to evaluate and rationalize the use of episiotomy in order to judge the effectiveness of the proposed benefits.
Surprisingly, the research highlighted controversial facts. Largely, it indicated that there were very little and even no health benefits for either mothers or babies from the routine use of episiotomy. Moreover, in many cases the procedure was found to have caused more harm than good. For instance, in its latest guideline on intra-partum care, NICE (2007) does not recommend performing a routine episiotomy during a spontaneous vaginal birth but only if a clinical reason is suspected…
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