What needs to be answered: For the proposed evidence-based practice solution given, who would be the key stakeholders? Give a description of those

Question What needs to be answered: For the proposed evidence-based practice solution given, who would be the key stakeholders? Give a description of those key stakeholders and why. For the proposed evidence-based practice solution given, propose a timeline to implement the solution. For the proposed evidence-based practice solution given, what are TWO SMART goals for it?For the proposed evidence-based practice solution given, what of types of internal and external data necessary for evaluation?What are two resources needed to sustain a permanent change with the evidence-based solution given? And what are two key indicators for continuous quality improvement?What would be your plan for reinfusion?INFO NEEDED TO ANSWER THE QUESTIONS ABOVE (REFERENCE YOU ARE LOOKING FOR TO ANSWER QUESTIONS) Evidenced based question:In patients or mother in second stage of labor, is having a perineal tear more effective in promoting faster recovery compared to having an episiotomy?Evidenced based solution: No longer using episiotomy and having perineal tears instead.EVIDENCED BASED BACKGROUND INFORMATION FOR EVIDENCED BASED SOLUTION:Increase rate of episiotomy in normal deliveries, leading to increase number of readmission due to episiotomy site infection, and increase length of stay of mothers post-delivery. In the United States, episiotomy is the most common performed obstetrical procedure. Episiotomy is a cut of the vagina and perineum performed surgically to avoid severe lacerations during childbirth. The use of episiotomy, however, does not avoid perineal trauma and sutures. This essay focuses on evaluation from different research literatures to determine the benefits and risks of episiotomy to perineal trauma among women during childbirth. World Health Organization (2018) does not recommend the implementation of episiotomy routinely for women who are undergoing spontaneous vaginal birth during the second stage of labor. “This up-to-date, comprehensive and consolidated guideline on essential intrapartum care brings together new and existing World Health Organization (WHO) recommendations that, when delivered as a package, will ensure good-quality and evidence-based care irrespective of the setting or level of health care. The recommendations presented in this guideline are neither country nor region specific and acknowledge the variations that exist globally as to the level of available health services within and between countries. The guideline highlights the importance of woman-centered care to optimize the experience of labor and childbirth for women and their babies.” Webb and Culhane (BIRTH 29:2 June 2002) wrote that episiotomy is probably even more harmful. Hospital episiotomy rates ranged from 20 to 73%, whereas the rate of third or fourth degree perineal lacerations varied from 4 to13% among hospitals. Jiang, et al (2017) in their research concluded that selective use of episiotomy in women from different countries (where a normal delivery without forceps is anticipated) result in fewer women with severe perineal/ vaginal trauma. The rationale for conducting episiotomies routinely to prevent severe perineal trauma is not justified by present evidence. More research is recommended where outcomes could be well measured. Shmuelli, et al (2016) identified several risk factors for mediolateral episiotomy. Among nulliparous, risk factors were maternal age, gestational age, regional analgesia, labor induction, meconium and birth weight. Episiotomy was associated with postpartum hemorrhage, and 3rd degree perineal tear. Episiotomy does not protect nulliparous women for obstetrical anal sphincter injury (OASI). For multiparous, risk factors were maternal age, gestational age, regional analgesia, meconium, birth weight and previous vaginal delivery. Episiotomy increased the risk for multiparous for obstetrical anal sphincter injury (OASI). Shmuelli, et al (2016) recommend the abandonment of routine episiotomy and reconsideration of the practice for selective episiotomy. Contributors for episiotomy in the operative vaginal delivery (OVD) were birth weight for nulliparous and previous vaginal deliveries for multiparous. Amorim, et al (2017) wrote that routine episiotomy is now considered a form of obstetric violence, female genital manipulation, if performed without giving the woman the right to make her own decisions with her own body. They also added that it is possible to implement a non-episiotomy protocol benefiting a group of women with full-term pregnancies and fetuses in the cephalic position. This is the first randomized clinical trial to avoid episiotomy to present recommended practice of selective episiotomy. In countries where episiotomy rates are higher, further studies need to be implemented to decrease episiotomy rates and hopefully end its practice. Health Science Science Nursing NUR 3643 Share QuestionEmailCopy link Comments (0)