Advances in protecting the perineum and reducing episiotomy in a maternity-school: historical series from 2010 to 2022.

INTRODUCTION

a positive and safe childbirth experience remains a challenge for parturients worldwide, including in Brazil.

OBJECTIVE

to describe and analyze changes in perineal care and episiotomy rates at a maternity teaching hospital in São Paulo, Brazil, and to identify the strategies that facilitate the implementation of evidencebased practices.

METHODS

a mixed-methods study analyzed changes in the model of care and episiotomy rates using medical record data (2010 to 2022), applying elements of the Change Laboratory methodology and the historical and cultural analysis of the activity system.

RESULTS

the episiotomy rate was 70% among primiparous women and 35% in the general population in 2010, decreasing to 0.7% and 0.5%, respectively, in 2022, with 75% of parturients (65% of primiparous women) having perineal integrity or first-degree perineal lacerations. Contributors to change: development of protocols, indicator record, mandatory recording of episiotomies, team training, reduced use of forceps, and strengthened communication strategies with parturients.

CONCLUSION

episiotomy rates can be reduced even in teaching hospitals when training is according to evidence-based practices and human rights.