Qualitative views on episiotomy amongst accouchers and pregnant women in a tertiary hospital in Southern Nigeria.

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Date: Sept-Dec 2020
From: Port Harcourt Medical Journal(Vol. 14, Issue 3)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 3,171 words
Lexile Measure: 1440L

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Byline: Dokuba. Tex-Jack, Chinemerem. Eleke

Background: In 2018, the World Health Organization recommended the restrictive use of episiotomy by midwives and obstetricians on pregnant women undergoing vaginal birth. Unfortunately, the use of episiotomy is still fairly common in Africa. Aim: We examined the qualitative views on episiotomy amongst accouchers and pregnant women at the Rivers State University Teaching Hospital in southern Nigeria. Methods: A cross-sectional design was employed. Census sampling was used to enrol 19 accouchers (house officer doctors = 7 and nurse-midwives = 12) and 43 third-trimester pregnant women. Narrative data were collected through focused group discussion using an interview guide and a digital audio recorder. Collected data were transcribed and subjected to coding, content and thematic analysis to enable categorisation of themes. Results: Respondents were 22-46 years old. The accouchers mentioned several indications for episiotomy which were not consistent with current evidence in literature. In contrast to pregnant women's views, the accouchers reported that episiotomy is a clinician's choice, so pre-informing the pregnant woman about it is optional. Pregnant women were of the view that they should be more involved by being the ones to decide whether they want to receive episiotomy or not. Even when the accouchers viewed episiotomy as having some clinical uses, the pregnant women suggested that episiotomy should be banned. Conclusion: The views of the accouchers and pregnant women were not totally aligned with each other. More sensitisation of accouchers and pregnant women is required to ensure re-alignment of views based on available evidence.


Episiotomy grew into a routine practice by midwives and obstetricians to pregnant women experiencing childbirth within the 20th century.[1],[2] It involves a deliberate surgical cut into the perineum of a pregnant woman with an intention to facilitate vaginal birth.[3],[4] It became a routine due to the historical belief that it made the birth canal wider, and prevented tear of the perineum.[5],[6] Consequently, up to 92% of childbearing women had episiotomies performed on them across countries.[7],[8] In view of this, several meticulously designed research studies began investigating the clinical value of episiotomy.[9],[10],[11] Its usefulness hence became an issue of debate following mounting empirical evidence in the wake of the 21st century.[12],[13] Several randomised studies demonstrated that episiotomy was associated with an increased risk of anal sphincter injuries.[13] Published evidence made the World Health Organization recommend an episiotomy rate of 10%, if episiotomy is not avoidable.[14] In addition, the International Federation of Gynaecology and Obstetrics opined that in view of available evidence, restrictive use of episiotomy is supported, especially in situations where there is a threat for perineal laceration, when it has already begun and when there is an urgency to deliver the fetus.[15] In line with the fore mentioned, episiotomy practice has since declined in Europe, however, this decline is yet to be observed in Africa and East Asia.[8],[16],[17]

The use of episiotomy in the absence of indication is a fairly common practice in Africa.[9],[16] This may have been driven by the existing knowledge asymmetry between accouchers and pregnant women.[13]...

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Gale Document Number: GALE|A656645791