IMPROVEMENT IN BIRTHING EXPERIENCE FOLLOWING CHANGE IN EPISIOTOMY PRACTICES AT TEACHING HOSPITAL IN INDIA

Background:- Episiotomy or perineotomy is a minor surgical procedure performed in labour room to facilitate delivery of the baby and to prevent injury to perineum. The analysis of the labour room statistics revealed that the rate of episiotomy was extremely high (87%).The episiotomy wound related complications resulted in extended hospital stay and unsatisfactory birthing experience among the delivered women. Methodology:- Different methods of root cause analysis like Fish bone analysis and Five Why method were used at Pravara Rural hospital,Loni a tertiary care hospital. Necessary educational programmes were implemented and policy decisions regarding indications of episiotomy were made. Regular monitoring and analysis was done to sustain the results. Results:-The historical data of three months before project implementation revealed that the rate of episiotomy was 87.00% among 1691 deliveries conducted. The reduction in rate of episiotomy was predominantly observed in multipara. At the end of eight weeks of QI project, the rate of episiotomy in primipara and multipara was 70.20 % and 20.00% respectively. The overall incidence of surgical site infection (SSI) in the obstetric unit decreased from 3.2 percent to 2.5 percent. Conclusion:- Implementation of quality improvement project helped in significant reduction in the rate of episiotomy. It indirectly helped in reduction of episiotomy related complications and hospital stay.