“Vi behöver lägga ett litet klipp”. Indikation, utförande och inhämtning av samtycke vid episiotomi : En kvalitativ studie baserad påintervjuer med barnmorskor och analys av riktlinjer.

Background: Episiotomy is an obstetric procedure that is performed worldwide and associated with a number of complications. 6,2 percent of women giving birth in Sweden in 2023 underwent an episiotomy. Previous research suggests that there are variations in indication and technique. Aim: To integrate midwives' experiences with the content of guidelines regarding indication,performance and consent to the performance of episiotomy. Method: Qualitative comparative design with a phenomenographic approach, analysing guidelines from two hospitals and interviews with midwives through content and document analysis, followed by triangulation. Result: Data from guidelines at two Swedish hospitals was analyzed. Ten midwives were interviewed. While there was consensus on indications for episiotomy, variations emerged regarding interpretation of indication, assessment, and tolerance. Performance was described similarly. Need for consulting with colleagues was expressed. Although the guidelines were generally seen as helpful, the midwives rarely turned to them, choosing other information sources. The increase in the number of episiotomies was associated with new research. Obtaining consent was described as challenging and poorly covered by the guidelines. Collaboration in the labour room was highly important. More prior knowledge among women and a clear description regarding patient information in the guidelines were needed. The guidelines formulated indications for prevention of sphincter damage differently. They differed in content and scope, with no contradictions in the recommendations detected. Neither fully met the needs of the midwives. Conclusion: Patient information about episiotomy should be provided in advance to ensure informed consent in an emergency situation. Guidelines should include obtaining consent and recommendations for information to patients. They should be concise, explicit and integrated into training. Midwives should be more involved in the development of guidelines.