The Development of Clinical Nursing Practice Guideline for the Assessment of Indication for Episiotomy,

Abstract

WorldHealth Organization recommended that episiotomy should not exceed 10% forspontaneous vaginal deliveries and it should be performed only withindications. This independent study aimed to develop CNPG for the assessment ofindications for episiotomy based on the national health and medical researchcouncil (NHMRC) and participatory development process.  Subjects included 6 nurse-midwives in thelabor room and 12 pregnant women who underwent vaginal delivery. Datacollection was done in November, 2012. Results of the CNPG consisted of 9components (18 nursing activities) including; 1) first time mother, 2) have a historyof heart disease, seizure, and hypertension, 3) a perineal  body shorter than 4 centimeters, 4) previousepisiotomy with suture or scar, 5) is a preterm birth, breech or mal-positions,6) estimated fetal weight > 3,500 grams, 7) poor maternal effort, 8) is aprolonged labor, and 9) Have fetal distress.  Mason criterion for standards of care wasused to verity the quality of the CNPG, in which results show that all 18activities were 100% completed. All 6 nurse-midwives reported high satisfactionlevels toward the CNPG in terms of usefulness, manpower and budget appropriate,practical to use, able to reduce unnecessary episiotomy and severity ofperineal tears/trauma. Additional comment was the indication about fetal weight> 3,500 grams may need to consider with other indication such as perinealelasticity.