Objective
To reconsider the use of episiotomy by critically appraising research papers with a high evidence level.
Method
We applied EBN methodology used to clarify clinical issues and searched for research papers and guidelines with a high evidence level. The keywords perineotomy/episiotomy, perineal laceration, perineal pain, and newborn were used. We focused on, and critically appraised, 2 research papers that are systematic reviews of RCT, and at the same time, we examined midwifery knowledge concerning minimizing perineal tears.
Findings
Our critical appraisal found that in both systematic reviews research queries were clearly defined and all points needed to insure validity were present. These systematic reviews advised that, "Compared to restrictive episiotomy, implementing routine episiotomy increases the risk of 'posterior perineal trauma'. It also increases the risk of 'healing complications' and 'perineal pain' at the time of hospital discharge. There is no evidence of reduction in the risk of 'urinary incontinence', 'dyspareunia', or the incidence of 'problems with newborn health'."
In addition, our examination of current midwifery knowledge confirms the possibility of minimizing perineal tears through perineal massage, perineal protection, and innovative birthing positions.
Conclusion
In women-centered midwifery care, the midwife seeks possible treatments that minimize perineal tears, and at the same time, shares evidence-based information appropriately with the aim of building a partnership with women so that women can choose care treatments themselves.