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Short abstract:

Drawing on an ethnographic study in two hospitals, we show that obstetricians and midwives detach from episiotomy, a controversial procedure, through a dynamic process of redefining its benefits/risks, promoting new or forgotten skills and managing professional tensions & organizational constraints.

Long abstract:

Episiotomy is a surgical procedure performed during childbirth to accelerate birth and/or prevent serious perineal tearing. It became routine, reaching a peak of 58.4% in 1996, before its effectiveness was questioned by an emerging patient movement, which prompted scientific authorities to publish guidelines (in 2005). Since, the national rate declined steadily, reaching an historical low of 8.3% in 2021. Recently, episiotomy entered the public debate as a new form of violence against women, known as "obstetric and gynaecological violence".

Drawing on new perspectives from the sociology of innovation looking into calls to 'do without' practices deemed problematic (Goulet & Vinck, 2023), we aim to analyze how obstetricians and midwives manage to reduce their use of episiotomy, in line with feminist demands. We conducted an ethnographic study (over 200 hours observations and 35 interviews) in two French maternity settings. In hospital A, a pioneer in criticising the (over)medicalisation of childbirth, midwives detached from episiotomy, in part transferring it to obstetricians. At the same time, they positioned themselves as key agents in helping obstetricians to reduce their recourse to episiotomy, by emphasising their skills in managing childbirth. This contrast with hospital B where episiotomy regulation was a top-down process decided by obstetricians aiming to implement a less interventionist approach of childbirth while keeping on performing over 5000 births/year. Our findings demonstrate that detachment from episiotomy isn’t achieved by returning to a previous state, but by a dynamic process of redefining its benefits/risks, visibilising new and forgotten know-hows, managing professional tensions and organizational.