Targeted Clinician Education and Reduction in Episiotomy Utilization: A Quality Improvement Initiative

Background: Reduction of unnecessary episiotomy remains a priority in efforts to improve obstetric quality and maternal outcomes. Despite evidence supporting restrictive use of episiotomy, clinician-level variation persists, contributing to rates that exceed national benchmarks. In August 2024, a targeted quality improvement initiative was launched within the Ob Hospitalist Group (OBHG) organization to provide focused education for clinicians with elevated episiotomy rates. The objective of this study was to assess changes in episiotomy utilization following completion of the educational intervention. Methods: This retrospective quality improvement analysis included clinicians within OBHG who were assigned targeted episiotomy education between August 2024 and April 2025 and completed the module by June 30, 2025. The education module was developed by a physician and certified nurse-midwife team using evidence-based best-practice resources and assigned using the organization’s web-based learning platform. Clinicians were assigned the mandatory education module if their 12-month episiotomy rate exceeded 8% and they had at least 20 eligible deliveries. Clinicians were not reassigned the module within a 12-month period. Baseline episiotomy rates were defined as the qualifying 12-month performance period that triggered module assignment. Post-education performance was tracked longitudinally, beginning with the first full quarter after module completion and including all subsequent available performance data through March 31, 2026. Outcomes included change in clinician episiotomy rates and the proportion of clinicians achieving improvement or rates below The Leapfrog Group’s national benchmark of 5.0%. Aggregate pre- and post-intervention episiotomy rates were compared using a two-proportion z-test, with statistical significance defined as p<0.001. Results: Seventy-seven clinicians met inclusion criteria and completed the educational intervention. During the baseline period, targeted clinicians performed 3,083 deliveries with 334 episiotomies, yielding an episiotomy rate of 10.83%. Following completion of the educational module, clinicians performed 2,693 deliveries with 116 episiotomies, yielding a post-intervention episiotomy rate of 4.31%. This represented an absolute reduction of 6.52 percentage points and a relative reduction of approximately 60% in episiotomy utilization. Comparison of pre- and post-intervention rates demonstrated a statistically significant improvement (z=9.23, p<0.001). Conclusion: A targeted, evidence-based educational intervention was associated with a significant reduction in episiotomy utilization among clinicians with elevated baseline rates, decreasing aggregate episiotomy rates from 10.83% to 4.31%. Most clinicians demonstrated measurable improvement, and nearly two-thirds achieved performance below the national benchmark. These findings suggest that individualized education coupled with longitudinal performance monitoring can effectively reduce practice variation and promote adherence to evidence-based obstetric care. Targeted clinician remediation may represent a scalable strategy for improving quality metrics and advancing maternal health outcomes across large obstetric practice networks.