The perception and knowledge about episiotomy: A cross-sectional survey involving healthcare workers in a low- and middle-income country

Abstract

Background: Episiotomy was introduced into clinical practice without clear evidence of its benefits.The knowledge and understanding of episiotomy guidelines and practice by healthcare workers is substandard in our setting; hence, the injudicious use of this procedure have led to high rates.Aim: To assess the knowledge, perception and practice of episiotomy by healthcare workers.Setting: Research was conducted in a Pietermaritzburg complex, South AfricaMethods: A questionnaire-based survey was conducted amongst healthcare workers regarding episiotomy practice. In addition to providing demographic data, the participants were requested to respond to 35 proposed statements regarding episiotomy practice. Data were analysed using SPSS (Statistical Package for the Social Sciences) software.Results: One hundred and forty-two midwives and 66 medical practitioners completed the questionnaires. There were variations in responses to several statements on episiotomy practice by medical practitioners and nurses based on their level of experience. This study found that the majority of HCWs did not have access to a protocol or policy on episiotomy practice in their units; furthermore, nor knowledge of the South African guidelines for maternity care on episiotomy practice. Significantly, more medical practitioners felt a need for more in-service training and an increase in the number of episiotomies performed under supervision. The commonly reported reason for performing an episiotomy by both medical practitioners and midwives was to reduce 3rd – 4th degree perineal tears.Conclusion: Healthcare workers in our setting displayed poor knowledge about the practice of episiotomy and were not aware of existing national guidelines on episiotomy practice.

Reasons for performing episiotomy during ectopic deliveries: An integrative literature review

“…Seijmonsbergen-Schermers et al 21 state that episiotomy may be necessary to prevent fetal suffering in cases of prematurity and that it may also be necessary in cases of prolonged labor to facilitate a faster delivery, which is consistent with the findings of Masuda et al 25 and other studies [22][23][24]26 . This practice reduces maternal effort and prevents fetal distress, thereby facilitating labor 27 .…”

“…This results in a lack of confidence during labor without instrumentation. Other authors 26,27 suggest that the recurrent practice of episiotomy may be due to a lack of theoretical and practical knowledge about the physiology of the perineum and the expulsive period of labor. The education of health professionals 23 and their experiences and training also influence the decision to perform this procedure.…”

Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis

“…The evidence showed that selective episiotomy with appropriate identification, diagnosis, and timing reduces the rate of practice and associated complications, 17 , 18 this is why World Health Organization (WHO) suggests a restrictive episiotomy policy other than the routine practice of episiotomy performed with care provider’s perception and attitude, misdiagnosis and without pertinent obstetric and maternal indication. 19 The extent of episiotomy practice was determined by the presence or absence of the protocol or policy for health care providers, work experience, and professions. 7 , 20 …”

“…3,16 The evidence showed that selective episiotomy with appropriate identification, diagnosis, and timing reduces the rate of practice and associated complications, 17,18 this is why World Health Organization (WHO) suggests a restrictive episiotomy policy other than the routine practice of episiotomy performed with care provider's perception and attitude, misdiagnosis and without pertinent obstetric and maternal indication. 19 The extent of episiotomy practice was determined by the presence or absence of the protocol or policy for health care providers, work experience, and professions. 7,20 Ethiopian ministry of health is providing emergency obstetrics and new-borne care (BEmONC) training in partnership with non-governmental organizations for obstetrics care providers to advance their performances and reduce maternal mortality and morbidity, increase institutional delivery and improve women's satisfaction with the quality of care by avoiding unnecessary obstetrics interventions or mistreatment.…”

Women’s Perceptions and Knowledge Toward Episiotomy in Qassim Region, Saudi Arabia

“…The experiences of those who had episiotomies align with O'Kelly et al (2017), emphasizing the need for better communication during consent, timely suturing, and post-procedure support [ 23 ]. Complications reported by Maphanga et al (2021) emphasize the importance of addressing and lessening complications through tailored care plans [ 24 ].…”