BACKGROUND:
Despite current recommendations against routine episiotomy, its practice remains widespread; however, numerous factors continue to influence midwives' clinical decision-making regarding its use.

OBJECTIVES:
This study aimed to investigate delivery room midwives’ views and experiences regarding episiotomy.

METHODS:
This explanatory sequential mixed methods study was conducted with midwives in maternity units in two Turkish provinces. The western province ranks among the ten with the lowest fertility rates, while the eastern ranks among the ten highest. In the first phase, a cross-sectional descriptive survey was administered to 149 midwives using a literature-based questionnaire on episiotomy. In the second phase, a phenomenological qualitative study was conducted through in-depth interviews with 11 midwives selected using a purposeful sampling method, based on the quantitative findings. Quantitative data were analyzed using SPSS with descriptive statistics and Chi-square tests; qualitative data were analyzed with MAXQDA, and themes and sub-themes were generated.

RESULTS:
The mean age of midwives was 32.88±8.37 years with 10.25±9.55 years of experience. Weekly births averaged 40.12±29.45, with 23.08±20.79 involving episiotomy. Leading reasons for episiotomy were fetal macrosomia (84.6%), primiparity (49.7%), and physician request (19.5%). While 65.1% of midwives made the episiotomy decision themselves, 86.6% considered the perineal condition. A significant difference existed between episiotomy rates in primiparous births and views on routine episiotomy necessity (p<0.05). Qualitative analysis identified three themes: midwives’ approaches to episiotomy, preference for risk-based decisions over physiological processes, and recommendations to reduce episiotomy rates. Midwives stressed protecting perineal integrity and the need for pregnant women’s childbirth preparation education and enhanced midwife decision-making competencies.

CONCLUSIONS:
Midwives' decisions regarding episiotomy are influenced by women’s compliance, physician guidance, and legal frameworks. Positive approaches aimed at reducing episiotomy rates should be encouraged, and education and awareness programs should be expanded.

KEY MESSAGE:
Episiotomy decisions are influenced by clinical, patient, physician, and legal factors; promoting education and midwife competence can reduce unnecessary procedures. Poster session 1 (Group A)