This thesis traces and analyses the evolution of obstetrical and midwifery doctrine and use of episiotomy in the United States and United Kingdom. In the U.S., the routinization of episiotomy resulted from strenuous lobbying efforts of a small group of obstetrician/gynecologists between 1915 and 1935. These physicians claimed episiotomy prevented perineal lacerations, infant mortality and morbidity, and gynecological problems. In the U.K., the liberal use of episiotomy came about during the 1970s from pressure from obstetricians although no overt campaigning for the practice occurred. In both countries adoption of routine episiotomy was encouraged by social forces which involved changes occurring in the dominant belief system in obstetrics, maternity care practices, and the obstetrics and midwifery professions. Questioning of the practice by childbirth activists and others eventually led to declines in episiotomy. This was facilitated, particularly in Britain, by midwifery interest in resisting obstetrical control. Neither the adoption nor rejection of routine episiotomy was informed by scientific evidence. This study contributes to understanding the process of innovation in maternity care.

No description available.