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The perception of episiotomy among Iranian women: a qualitative study

02 January 2022
Volume 30 · Issue 1



Around 70% of women who give birth vaginally experience perineal injury during childbirth, which may happen spontaneously or as a result of the incision made to facilitate childbirth. There are very few studies on the perceptions of episiotomy recipients about these services. Therefore, investigating these women's perception is crucial for providing appropriate care.


This qualitative study examined 20 women from hospitals and health centres who had undergone episiotomy using in-depth semi-structured interviews. Data were analysed using conventional content analysis and the accuracy and rigour of the data were assessed using the Lincoln and Guba criteria.


The ‘change in perception and behaviour’ theme encompassed one category of negative experiences and views about episiotomy and a second category covering positive views.


Women's perceptions of episiotomy contained both positive and negative views. Since healthcare systems should support mothers' physical and mental health, it is recommended that health policymakers devise plans to boost factors that lead to positive views and eliminate those contributing to negative experiences and views.

Episiotomy entails widening the vaginal opening in the second stage of labour by making an incision in the perineal muscles (Rasouli et al, 2016). Although the rate of episiotomy reduced in some countries between 1992 and 2003, its prevalence has been reported as 40% in England, 54% in North America and 99% in Eastern Europe; in Iran, the rate has been reported as 97% in primiparous women (Kajoye Shirazie et al, 2009; Cunningham et al, 2010). In the World Health Organization's (WHO, 2017) Maternal Health and Safe Motherhood Programme, episiotomy is classified as a method that is often misused, because there is evidence that its routine use causes harm. In fact, routine episiotomy is associated with increased grade 3 and 4 rupture and damage to the anal sphincter muscles (WHO, 2017). This injury then needs to be repaired and pain, bleeding, infection and dyspareunia are among the problems experienced by women after repair (Jiang et al, 2017). In the early 1990s, increased pressures caused a reduction in the rate of routine episiotomy in England, but in general, recommendations to reduce episiotomy rates have been mainly based on the views of health service providers, with little consideration for women's views or priorities (Jiang et al, 2017).

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