Evaluation of Interventions Based on Behavioral Sciences to Reduce Episiotomy Use

Number of episiotomies performed among patients having a vaginal delivery.

Episiotomy: surgical incision made in the perineum during childbirth to enlarge the vaginal opening and facilitate the delivery.

There are two main types of episiotomies, classified based on the direction of the incision: Median (the incision is made straight down from the vaginal opening towards the anus) and mediolateral (the incision is made at an angle [usually 45 degrees] from the vaginal opening towards the side, away from the anus).

Number of episiotomies performed with an indication documented in the medical record among patients having a vaginal delivery.

Potential indications:

Nonreassuring fetal status, prolonged or difficult labor, operative vaginal delivery, shoulder dystocia, large for gestational age fetus, breech delivery, rigid perineum, maternal fatigue or exhaustion, preterm delivery.

Number of assisted deliveries among patients having a vaginal delivery. Assisted vaginal delivery refers to the use of specialized instruments, such as forceps or a vacuum device, to help guide the fetal head out of the birth canal during childbirth.

Number of perineal and cervical lacerations (composite outcome) among patients having a vaginal delivery.

The composite outcome will include any of the following:

Perineal Lacerations:

First degree: Injury to Perineal skin only. Second degree: Injury to perineum involving perineal muscles but not involving anal sphincter. Third degree: Injury to perineum involving anal sphincter complex. 3a: Less than 50% of external anal sphincter thickness torn. 3b: More than 50% external anal sphincter thickness torn. 3c. Both external anal sphincter and internal sphincter torn. Fourth degree: Injury to perineum involving anal sphincter complex (external anal sphincter and internal anal sphincter) and anal epithelium.

Cervical Laceration:

A cervical laceration during delivery refers to a tear or injury to the cervix that occurs during childbirth.

Administration of any of the following :

RBCs, fresh frozen plasma (FFP), platelets and cryoprecipitate

Estimated or calculated blood loss (mL).

Percentage (%) of red blood cells (RBCs) in the total blood volume.

Description of Nonsteroidal Antiinflammatory Drugs and Opioids administered

Brief voluntary and anonymous survey designed by the research team to be answered by ~300 patients.

Surgical site infection related to episiotomies, perineal, or cervical lacerations that occurred at the site of these surgical or traumatic wounds after childbirth.

Partial or complete wound reopening along a surgical incision or laceration previously closed (e.g., episiotomies, perineal lacerations, cervical lacerations).

5-Minute Apgar Score Components:

The Apgar score assesses five key signs of a newborn's health, each assigned a score of 0, 1, or 2, for a total possible score of 10:

• Appearance (skin color)

• 0: Blue or pale all over.
• 1: Body pink, but extremities blue.
• 2: Entire body pink.
• Pulse (heart rate)

• 0: No heartbeat.
• 1: Fewer than 100 beats per minute.
• 2: At least 100 beats per minute.
• Grimace (reflex irritability, response to stimulation)

• 0: No response to stimulation.
• 1: Grimace or weak response when stimulated.
• 2: Strong cry or active withdrawal in response to stimulation.
• Activity (muscle tone)

• 0: Limp, no movement.
• 1: Some flexion of extremities.
• 2: Active movement.
• Respiration (breathing effort)

• 0: Not breathing.
• 1: Weak or irregular breathing.
• 2: Strong cry, normal breathing.

Transfer and care of a newborn in the Neonatal Intensive Care Unit (NICU) to provide intensive medical care for premature, ill, or high-risk newborns.

Neonatal death refers to the death of a newborn within the first 28 days of life. This period is further divided into two phases:

• Early neonatal death: Neonatal death within the first 7 days of life.
• Late neonatal death: Neonatal death occurring between 7 and 28 days of life.