Personalized Workplace Audit as an Option for Reducing Episiotomy Rates

Abstract Background An adequate rate of episiotomies is seen as a factor indicating the quality of an obstetrics clinic. Even though professional associations provide guidelines on episiotomy indication, it is often performed solely upon the arbitrary decision of the assisting physician present at the labor. The authors of the present paper evaluate the impact of personal audit on the overall episiotomy rate. Methods The sample includes all women who have given birth at the 2nd Department of Gynecology and Obstetrics of University Hospital Bratislava between 2018 and 2023. In 2021, the number of episiotomies performed by 12 physicians between 2018 and 2020 was analyzed. Each physician was subsequently presented with their data for nulliparous term singleton vertex deliveries (NTSV), excluding operational birth procedures. The episiotomy frequency of individual physicians was subsequently compared to the data from the period between 2021 and 2023. Results The frequency of episiotomies decreased significantly in 11 out of the 12 physicians included in the analysis. Overall, the measure resulted in a decrease of episiotomy frequency at the clinic from 35.3% to 25.3% ( p < 0.0001, OR: 0.62) and an increase of the number of women giving birth without injury from 21.7% to 24.7% ( p < 0.0001, OR: 1.18). We have noted no statistically significant increase in the rate of third- and fourth-degree injuries (3.9% vs. 4.0%). Conclusion A personalized audit of episiotomy frequency may result in a decrease of the number of episiotomies performed at a given clinic.