ANOVA of the effects of hospital level and work experience on episiotomy
| Use, knowledge and attitude towards episiotomy | Experience | Hospital level | Experience×hospital level | |||
| Obstetricians | Midwives | Obstetricians | Midwives | Obstetricians | Midwives | |
| Nulliparous | 1.58 (0.198) | 3.14 (0.025) | 5.43 (0.006) | 19.07 (0.000) | 2.87 (0.017) | 1.18 (0.317) |
| Multiparous | 1.76 (0.158) | 0.89 (0.444) | 2.39 (0.096) | 5.33 (0.005) | 0.86 (0.511) | 0.60 (0.731) |
| Type of episiotomy used | 0.74 (0.530) | 0.29 (0.832) | 1.16 (0.317) | 0.20 (0.822) | 0.51 (0.769) | 0.31 (0.934) |
| Reasons for performing episiotomy* | ||||||
| Reduce third-degree and fourth-degree perineal laceration | 0.13 (0.941) | 1.15 (0.326) | 3.37 (0.037) | 5.03 (0.007) | 0.86 (0.507) | 0.51 (0.798) |
| Operative birth | 1.20 (0.312) | 4.01 (0.008) | 0.06 (0.943) | 1.07 (0.345) | 0.32 (0.898) | 0.98 (0.439) |
| Thick/swollen perineum | 3.49 (0.018) | 0.43 (0.731) | 0.15 (0.863) | 0.22 (0.800) | 0.68 (0.639) | 0.49 (0.816) |
| Easy to suture | 1.28 (0.285) | 0.34 (0.793) | 6.37 (0.002) | 3.58 (0.028) | 1.63 (0.156) | 1.75 (0.107) |
| Shorten the second stage of labour | 1.73 (0.165) | 1.71 (0.164) | 1.15 (0.319) | 1.09 (0.338) | 0.82 (0.539) | 1.18 (0.315) |
| Afraid of fetal distress | 1.34 (0.266) | 1.29 (0.278) | 2.55 (0.082) | 3.28 (0.038) | 0.20 (0.962) | 0.68 (0.663) |
| Other | 1.00 (0.396) | 1.31 (0.268) | 0.31 (0.734) | 1.16 (0.314) | 0.36 (0.878) | 0.82 (0.555) |
| Prevalence of postpartum haemorrhage | 2.30 (0.080) | 1.36 (0.254) | 0.72 (0.487) | 1.24 (0.291) | 0.70 (0.625) | 0.99 (0.430) |
| Prevalence of fetal distress | 0.32 (0.813) | 1.39 (0.245) | 7.11 (0.001) | 1.56 (0.211) | 1.23 (0.300) | 0.62 (0.711) |
| Faster wound healing? | 3.03 (0.032) | 0.57 (0.635) | 4.04 (0.020) | 2.68 (0.069) | 1.35 (0.246) | 0.91 (0.489) |
| Less perineal pain? | 0.79 (0.500) | 1.13 (0.035) | 5.21 (0.007) | 0.40 (0.700) | 2.70 (0.024) | 1.06 (0.386) |
| Urinary incontinence | 0.42 (0.737) | 0.58 (0.626) | 0.70 (0.501) | 2.60 (0.075) | 1.31 (0.264) | 0.66 (0.681) |
| Pelvic organ prolapsed | 1.12 (0.345) | 0.87 (0.458) | 0.56 (0.571) | 1.96 (0.142) | 0.68 (0.639) | 1.18 (0.314) |
| Episiotomy rate (of 45%) is low/normal/high | 2.19 (0.093) | 1.92 (0.125) | 1.05 (0.352) | 0.96 (0.382) | 0.79 (0.560) | 0.77 (0.597) |
| Routine episiotomy is appropriate for nullipara | 0.22 (0.884) | 0.66 (0.576) | 3.70 (0.028) | 2.73 (0.066) | 0.24 (0.946) | 0.63 (0.703) |
| Routine episiotomy is appropriate for multipara | 0.33 (0.804) | 0.35 (0.789) | 0.29 (0.746) | 0.69 (0.501) | 1.14 (0.345) | 0.46 (0.837) |
| Obstacles to reducing episiotomy rates* | ||||||
| Not trained to minimise tears/keep perineum intact | 0.93 (0.428) | 1.77 (0.152) | 0.02 (0.978) | 0.82 (0.439) | 1.81 (0.115) | 1.15 (0.332) |
| No time to wait for the perineum to stretch | 0.19 (0.901) | 1.41 (0.239) | 0.47 (0.627) | 0.61 (0.546) | 0.41 (0.842) | 1.12 (0.351) |
| Hard to change traditional practice | 1.91 (0.132) | 0.88 (0.450) | 0.86 (0.426) | 1.84 (0.160) | 0.56 (0.733) | 1.49 (0.179) |
| Women expect an episiotomy | 0.44 (0.727) | 0.18 (0.907) | 0.44 (0.645) | 1.49 (0.225) | 0.97 (0.440) | 0.46 (0.839) |
P values are in parentheses.
The bold values indicate that it is significant (P values<0.05)
*More than one response possible.
ANOVA, analysis of variance.