HUMAN RESOURCES FOR HEALTH (HRH) MIDWIVES MENTORING PROGRAM AND EPISIOTOMY RATES AT MUHIMA HOSPITAL, RWANDA: A RETROSPECTIVE CROSS-SECTIONAL STUDY

BACKGROUND: Despite strong evidence against routine episiotomies, numerous unnecessary episiotomies occur each year in Rwanda and other countries leading to long-term maternal complications. The Ministry of Health-led Human Resources for Health (HRH) program in Rwanda aims to improve the quality of health care delivery by increasing the capacity of doctors, nurses, and midwives. HRH pairs international and domestic doctors, nurses, and midwives to provide in-service training and daily bed-side mentorship, and to exchange best practices. This study evaluates the effect of the HRH midwifery in-service mentoring program on change of episiotomy rates at Muhima Hospital in Kigali, Rwanda.

METHODS: This retrospective pre-post intervention study of episiotomy rates used data from vaginal births sequentially sampled from the hospital birth register during six-month periods before (2012, n=264) and after (2014, n=394) the intervention was implemented. Percentages and chi-squared tests were used to compare episiotomy rates before and after the intervention, including in subgroups of women. Logistic regression was used to test for any differences between groups.

RESULTS: Pre-intervention and post-intervention populations were similar in terms of age (p=0.488), parity (p=0.080), shift of birth (p=0.280), and baby weight (p=0.190). The change in episiotomy rate from 35.6% in 2012 to 11.7% in 2014 was statistically significant (p<0.001), after adjusting for other characteristics.

DISCUSSION: This study found a substantial decrease in episiotomy rates at Muhima Hospital following implementation of a two-year inservice mentoring program. More research is needed to separate the effects of general health system strengthening versus the intervention on episiotomy rate, but initial findings are positive.

Keywords
Evidence-based practice; Episiotomy; Delivery; Obstetric; Midwifery; Africa; Education; medical