PURPOSE:
To reduce the number of routinely performed episiotomies and align clinical practice with the World Health Organization (WHO) recommended level.

DISCUSSION:
Episiotomy is one of the most common obstetric surgical procedures and is primarily performed by midwives. Evidence-based guidelines and regular training support professional development and promote lifelong learning. To reduce the incidence of episiotomy and reach the WHO recommended target of 10%, a structured theoretical and practical training program was implemented in 2020 for staff working in the delivery ward (midwives and residents, n=53). The theoretical component covered the history of episiotomy, indications, complications, and principles of correct technique. The practical part focused on hands-on skills application in clinical practice, including suturing and postpartum wound care. The total duration of the training was 16 hours. The course was integrated into the basic/critical competencies training program and made mandatory for all midwives and residents working in the delivery ward. To ensure consistent quality of care, the same methodology is also used in the training of midwifery students at the Tartu Applied Health Sciences University. In addition, staff have access to the GynZone e-learning platform to support ongoing skill development.

EVIDENCE WHERE RELEVANT:
In 2017, the rate of episiotomies at the Women’s Clinic of Tartu University Hospital was 22.7% of all vaginal births, with a third- and fourth-degree perineal tear rate of 1.2%. After four years of consistent training, the episiotomy rate decreased to 2.8% in 2024. Importantly, this reduction was not associated with an increase in severe perineal trauma—the rate of third- and fourth-degree tears remained stable at 1.6%. Participant feedback on the training has been positive, and the program is regarded as relevant and necessary.

KEY MESSAGE:
episiotomy, training, midwife, Estonia, quality improvement Poster session 3 (Group B)