Women’s experience of episiotomy: a qualitative study from China

He, Siyuan; Jiang, Hong; Qian, Xu; Garner, Paul

doi:10.1136/bmjopen-2019-033354

Cited by 31 publications

(32 citation statements)

References 38 publications

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“…Episiotomies have diverse meanings to women depending on social context, professional background and personal perspective [33]. This means that they can have a wide range of physical and psychological consequences [34]. Women in this study did not perceive their episiotomy as a negative experience and felt it had been necessary to expedite a safe birth.…”

Section: Discussionmentioning

confidence: 74%

“…Women in this study appreciated the optimal communication from their midwives as a means of understanding their maternity care. One study reports that episiotomies have been performed without women's consent and understanding [34] and one woman in this study reported no memory of the episiotomy being performed. It is, however, unclear as to what effect analgesia, such as diamorphine, can have on memories of intrapartum events.…”

Section: Discussionmentioning

confidence: 76%

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Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

et al. 2021

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Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a severe form of perineal trauma that can occur during vaginal birth. Long-term morbidities include anal incontinence and psychosocial disorders. To reduce these injuries within England, Scotland and Wales, the OASI Care Bundle was introduced to 16 maternity units (January 2017–March 2018). The OASI Care Bundle comprises four elements: (1) antenatal information, (2) manual perineal protection, (3) medio-lateral episiotomy (when indicated) and 4) recognition and diagnosis of tears. As part of the project evaluation, a qualitative study was conducted to explore women’s experiences of the OASI Care Bundle. Methods Semi-structured interviews were conducted with women (n = 19) who received the OASI Care Bundle as part of their maternity care. This was to explore their experience of each element. A thematic analysis of the interview data was performed. Results Three themes were identified: (1) memories of touch, whereby women reported that a ‘hands-on’ approach to perineal protection was a positive experience; (2) midwife as a supportive guide, where women reported that good communication facilitated a calm birth and post-birth diagnosis; (3) education: women need more information about perineal trauma. Conclusion This study contributes to the literature through its exploration of women’s experiences of perineal protection techniques and diagnosis of perineal trauma. Interviewed women indicated that they did not experience any of the care bundle elements as an intrusion of their physical integrity. Additionally, an urgent need was identified for more information about perineal trauma in terms of risk, prevention and recovery.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 76%

Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

et al. 2021

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“…49 Instead of expectation, the effect of episiotomy was described in Chinese as a 'psychological shadow' of postpartum sexual life and the next childbirth, which are societal norms that meant women are expected to suffer alone and not complain. 50 As shown in tables 5 and 6, the episiotomy practice at different hospital levels showed difference. Compared with secondary hospitals, the rate of episiotomy in tertiary hospitals was lower, and the knowledge level of obstetricians and midwives was higher, probably as a result of staff qualification being higher and standardised training being disseminated with the latest evidence-based medicine in tertiary hospitals.…”

Section: Obstacles To Reducing the Rate Of Episiotomymentioning

confidence: 95%

Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China

Yang

Bai

2021

BMJ Open

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ObjectiveEpisiotomy is still performed widely by obstetricians and midwives in some Chinese maternity units, but the reasons are unknown. This study aims to determine the knowledge, attitude and experience towards the practice of episiotomy among obstetricians and midwives in China’s public hospitals and consider strategies to reduce its practice.MethodsA cross-sectional web survey using a self-administered questionnaire was conducted among obstetricians and midwives in 90 public hospitals in Henan Province, China.Results900 (82.21%) participants completed the questionnaire. Average knowledge level (4.15, SD=1.10) on complications and overuse was identified among participants. Episiotomy was performed more frequently in secondary hospitals than in tertiary hospitals (p<0.05). Senior clinicians were more likely to perform episiotomy than younger ones (p<0.05). Almost half of the clinicians (42.11%) considered the current rate of episiotomy (45%) to be right or too low. The most common reason for performing episiotomy identified by obstetricians (83.94%) and midwives (79.69%) was to reduce third-degree or fourth-degree perineal laceration. Both obstetricians (80.29%) and midwives (82.57%) agreed that the most significant obstacle to reducing the rate of episiotomy was lack of training on reducing perineal tears.ConclusionIn sum, episiotomy was driven by previous training, practitioners’ experience and local norms rather than the latest medical evidence. Clinicians in secondary hospitals and senior clinicians are key training targets. It is urgent to improve current clinical policies and surgical procedure guidelines for obstetricians and midwives regarding episiotomy.

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“…Pain can cause reduced mobility and discomfort, interfere with the establishment of breastfeeding, newborn care development, and self-care activities, such as sleep, rest, urination, and bowel movements. It can also impact the sexual relationship and home life, causing psychological and emotional problems during the puerperium (1)(2) . Therefore, proper perineal pain management is necessary, including evidence-based best practices, for women's quality care in the postpartum period.…”

Section: Introductionmentioning

confidence: 99%

Implementation of evidence-based practices in the perineal pain management in the postpartum period

Tomaz

Brito²,

Riesco³

2022

Rev. Bras. Enferm.

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Objectives: To implement strategies for managing perineal pain in puerperal women admitted to a public maternity hospital in São Paulo state and to evaluate their compliance with evidence-based practices. Methods: Implementation study using the JBI model conducted with nursing professionals and puerperal women between September and December 2019. Interviews with puerperal women and medical record data were used to audit seven evidence-based criteria. The interventions adopted included a care protocol, professional training, and folder elaboration for puerperal women. Results: Prior to the intervention, deficits in audited practices and obstacles to pain management were identified, which were overcome by the strategies employed. The follow-up audit demonstrated improvements in compliance with best care practices. Conclusion: There was an increase in the criteria compliance evaluated after the implemented strategies, contributing to improving the nursing care results in the perineal pain management based on the best scientific evidence.

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Women’s experience of episiotomy: a qualitative study from China

Cited by 31 publications

References 38 publications

Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China

Implementation of evidence-based practices in the perineal pain management in the postpartum period

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