|Year : 2015 | Volume
| Issue : 1 | Page : 25-29
Perception of episiotomy among pregnant women in Kano, North-Western Nigeria
Muhammad Yusuf Abubakar1, Maryam Muhammad Suleiman2
1 Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria
2 Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||8-May-2015|
Muhammad Yusuf Abubakar
Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin Kudu, Jigawa
Source of Support: None, Conflict of Interest: None
Background: Episiotomy can be defined as a surgical incision made at the perineum to widen the introitus and facilitate delivery. Objective: To assess the perception of women on episiotomy. Design: A prospective cross sectional study. Settings: This was the antenatal clinic of Aminu Kano Teaching Hospital, Kano. Methods: All consented pregnant women at booking were recruited and interviewed. Results: Over the six weeks period of the study, 109 women were interviewed. Majority of the women (94.5%) have heard of episiotomy and 81.7% were able to describe it as a surgical incision to facilitate delivery. Most of their sources of information were from friends/relatives (52.3%). Fifty seven (52.3%) out of the 109 women have had episiotomy and 'Big baby' as described was the commonest indication for the episiotomy (62.5%). Majority of the women (66.1%) Did not have prior counselling before episiotomy and 76.8% Did not have any complication following the repair. Most of the women (69.6%) had their episiotomies repaired within an hour of delivery. Twenty eight (49.1%) out of the 56 women who had episiotomy do not believe women should be routinely given episiotomy at delivery while 40.4% of the women were of the opinion that it should be routine to avoid injury to the baby. Majority of the women (82.1%) advocated for anaesthesia prior to episiotomy. Conclusion: There is a good knowledge of this procedure among pregnant women in AKTH Kano.
Keywords: Episiotomy, Kano, perception, pregnant women
|How to cite this article:|
Abubakar MY, Suleiman MM. Perception of episiotomy among pregnant women in Kano, North-Western Nigeria. Niger J Basic Clin Sci 2015;12:25-9
|How to cite this URL:|
Abubakar MY, Suleiman MM. Perception of episiotomy among pregnant women in Kano, North-Western Nigeria. Niger J Basic Clin Sci [serial online] 2015 [cited 2021 Sep 26];12:25-9. Available from: https://www.njbcs.net/text.asp?2015/12/1/25/156676
| Introduction|| |
Episiotomy is the second commonest surgical procedure in obstetric practice after the cutting of the umbilical cord at delivery. It can be defined as a surgical incision made at the perineum to widen the introitus and facilitate delivery. ,
It was introduced as an obstetric procedure more than 200 years ago; and since then, the practice went through a number of reviews starting from the 1920s when routine episiotomy was advocated to the 1980s when restrictive use of episiotomy became the recommended practice. ,
Episiotomy means different things to different individuals and groups, the meaning being socially constructed depending on social context, professional background and personal experience. 
The incidence of episiotomy ranges from 20.0% to 62.5% worldwide with a wide inter-centre variation. , In Nigeria, the incidence ranges from 20.8% to 54.9%. , The incidences were 45%,  54.9%  and 35.6%  in the south-east, south-west and north-western regions of Nigeria, respectively.
There is a popular belief that episiotomy could be performed painlessly without anaesthesia, especially if performed at the peak of uterine contraction when the perineum is fully stretch. This belief was later found to be baseless as women experience considerable pain during episiotomy, which can be prevented by using local anaesthetics. 
Despite the acclaimed benefits that were traditionally ascribed to routine episiotomy such as reductions of severe perineal laceration, foetal trauma, urinary stress incontinence and improved wound healing; the procedure is not without complications, some of which include perineal pain, haemorrhage, local anaesthetic toxicity, wound infection, wound breakdown and also interference with the mother's comfort during the postpartum period. ,
Records suggest that women who have an episiotomy do not have significantly improved labour, delivery and recovery compared with those who do not have one.  In practice, women are not necessarily informed of the specific risks and benefits associated with performing episiotomy, and rarely is written consent obtained, somehow abrogating the standard set for every other surgical procedure. 
It has been adduced that one of the reasons why some women in our environment receive antenatal care in hospitals but elect to deliver in unlicensed maternity homes where episiotomies are never performed and intrapartum care may be inadequate was due to the fear of episiotomy.  Studies have shown that higher episiotomy rates were found more among doctors, most especially Obstetricians. ,,
Episiotomy in one series was more frequently performed in primiparae (90.4%) and the commonest indication was to protect the perineum from imminent tear (80.7%). 
Restrictive episiotomy as against routine episiotomy is been advocated in the current obstetric practice  and individualizing each patient would go a long way to achieving this objective. A Cochrane review of six (6) studies comparing restrictive versus routine use of episiotomy concluded that, 'Compared with routine use, restrictive episiotomy involved less posterior perineal trauma, less suturing and fewer healing complications but associated with more anterior perineal trauma. No difference in severe vaginal or perineal trauma, dyspareunia, urinary incontinence or severe pain measures'. 
This study aimed at assessing the knowledge, the experience (s) of women with regards to previous episiotomy, the complications as well as the view of the women regarding routine episiotomy.
| Materials and methods|| |
Study design and study area
This was a prospective cross-sectional study that was conducted over 6 weeks at the booking clinic of Aminu Kano Teaching Hospital, Kano.
Kano is the most populous city in Northern Nigeria with a population of 9.4 million people (2006 census). It is the commercial nerve centre of Northern Nigeria. The inhabitants are mainly traders and civil servants. They are mainly of Hausa/Fulani tribe of the Islamic faith.
Aminu Kano Teaching Hospital is one of the tertiary health facilities in Kano. It was established in August 1988 as the teaching hospital for Bayero University Medical School.
Obstetrics and Gynaecology department is one of the clinical departments in the hospital, with four teams of Consultants. The antenatal clinics operate on Mondays, Tuesdays, Wednesdays and Thursdays from 8.00 am to 1.00 pm. The booking clinic is held every working day except Friday.
Recruitment and data collection
All consenting pregnant women at booking visit were recruited and interviewed. For each woman an informed verbal consent was obtained following detail explanation of what the study entails and the possible benefits in future obstetric care. The questionnaires which were partly pre-coded and partly open-ended were pre-tested and administered to assess their socio-demographic data, knowledge of episiotomy, experience regarding previous episiotomy, complications and their view regarding routine episiotomy.
The data obtained were analyzed and presented as numerical, simple proportions and percentages using Statistical Package of Social Sciences (SPSS) version 16 statistical software. Also Chi-square test was conducted to compare certain variables using P < 0.05 as statistically significant.
| Results|| |
One hundred and nine (109) consented pregnant women at their booking visits were interviewed during the 6-weeks period of the study. The findings are depicted in the tables below [Table 1], [Table 2], [Table 3].
Majority of the women interviewed (70.6%) were between the ages of 25-34 years with the mean age of 29 ± 6.0 years. Most of the women (78.9%) were of low parity group (0-4) with a mean parity of 3.6 ± 1.9.
Eighty-seven of the women (79.8%) were Hausas and most were of the Islamic faith (93.6%).
Most of the women had formal education with secondary and tertiary education being 35.8% and 49.5%, respectively.
Majority of the women (94.5%) have heard of episiotomy and 81.7% were able to describe it as a surgical incision done to facilitate delivery. Only few of the women could not describe it well and interpreted it as a tear, an operation or don't actually know what it means as seen in the [Table 2] above.
Most of the sources of information of the women were from friends/relatives and health personnel; 52.3% and 34.9%, respectively.
Fifty-seven (52.3%) out of the 109 women interviewed had episiotomy in their previous confinements and 'Big baby' as they described it was the commonest indication for the episiotomy (62.5%). Only 7.1% of the women do not know the indication for their episiotomy.
Majority of the women (66.1%) did not have prior counselling before the episiotomy cut and 69.6% had their episiotomies repaired within an hour of delivery. Forty-three (76.8%) do not had any complication following the repair while a few had perineal discomfort with associated difficulty on sitting (14.3%) and 8.9% had episiotomy breakdown which were either treated conservatively or by secondary repair.
Twenty-eight (49.1%) out of the 56 women who had episiotomy do not believe women should be routinely given episiotomy at delivery while 40.4% of the women were of the opinion that women should be routinely given episiotomy to avoid injury to the baby.
Majority of the women (82.1%) advocated for anaesthesia prior to episiotomy while few (7.1%) do not because they believed that it delay wound healing and due to the fact that it does not completely take away the pain [Table 4], [Table 5], [Table 6], [Table 7], [Table 8].
| Discussion|| |
Assessment of patients' perception on certain procedures is very important as it aids in improving the standard of care. Medical care assessed to be of high quality according to the provider-defined criteria may not necessarily be acceptable to patients; likewise care perceived to be satisfactory by the patients may not be the standard quality care.
This study attempts to assess the knowledge and experiences of women regarding episiotomy so as to serve as the basis for improved standard of practice.
From the study, it could be seen that there is high awareness of episiotomy among the women interviewed. Majority of the women (94.5%) had heard of episiotomy and 81.7% were able to describe it as a surgical incision done to facilitate delivery. Only 5.5% of the women have never heard of it and fewer women could not describe it correctly. These findings were similar to the findings of Inyang-Etoh and co-worker  who found that 61% of the 275 parturient studied had knowledge of what episiotomy meant.
Friends/relatives appeared to be the major source of information on episiotomy in these women accounting for 52.3%, followed by health personnel who accounted for 34.9%. These findings underscores the need for this study. Since the major source of information in most of these women was from friends/relatives, it is pertinent to ensure that the right information is being communicated and also stress the need for health personnel to re-double their efforts in raising the awareness of these women by inculcating detailed discussion on episiotomy in the health talks given to these women during antenatal care.
Out of the 109 women interviewed, 57 (53.3%) had episiotomy done in their previous confinements and majority of these women (92.9%) knew the indication for their episiotomies as they were told after delivery before or at repair. Only 7.1% of them did not know why the procedure was performed on them up to the time of discharge. 'Big baby' as they described it was the commonest indication for the episiotomy (62.5%), followed by assisted delivery (30.4%). This finding was similar to the finding of Ola and co-workers  where they found that 80.7% of the episiotomy was for protecting the perineum from possible tears.
Majority of these women were not counselled before the procedure was performed on them (66.1%). Only 19.6% had prior counselling. This finding is similar to the findings of Inyang-Etoh and co-worker  where 61.5% of the women studied were also not counselled prior to the procedure.
Majority of the women who had episiotomy did not experience any complication (76.8%). Only few had some complications such as perineal discomfort with difficulty in sitting (14.3%) and episiotomy breakdown (8.9%). These findings were similar but lower than the findings of Inyang-Etoh and co-worker  but differ from what Chigbu and co-workers  found that episiotomy use was associated with major perineal lacerations and increased length of hospital stay. Although there was no statistically significant difference between parity and complication rate but the low complication rate observed in this study may be due to the fact that majority of the women interviewed were multiparous (66%) who may be more experienced and conversant with episiotomy care compared to the primiparae (11%) who may be less experienced with resultant complications.
Majority of the women who had episiotomy had their episiotomies repaired within an hour of delivery (69.6%). This was also similar even though lower than what Inyang-Etoh and co-worker  found where 97.1% of the women in their study had their episiotomies repaired within an hour of delivery.
Concerning whether episiotomy should be recommended to all parturient, the respondents held different opinion in that respect. Twenty-three (40.4%) believed that all women should have it at delivery to protect the baby from birth trauma while 49.1% were of the opinion that it should not be routine but when indicated and 10.5% could not decide whether parturient should have it or not.
On the issue of whether local anaesthesia should be administered prior to performing episiotomy, 82.1% of the women agree to the local infiltration with an anaesthetic agent while 7.1% did not because of their belief that it delays healing and do not completely take away the pains. These claims should not be completely overlooked but need to be further evaluated in future studies, as we have seen from a previous study by Senanayake and co-workers in Sri Lanka  who described the popular belief that episiotomy can be performed painlessly especially when performed at the peak of uterine contraction as baseless.
Western education was observed to be associated with high level of awareness among the respondents and when the finding was subjected to test of association, it showed a statistically significant difference between the two groups as could be seen in [Table 4] above.
It could also be seen from the study that, the low parity groups had higher level of awareness among the respondents. Chi-square test showed a statistically significant difference between the groups. This may be due to the fact that the low parity groups had more western education than the high parity groups as seen in [Table 8] above.
Both level of education and parity seemed not to have influenced the complication rate among the respondents. There was no statistically significant association between level of education and parity with the complication rate among the respondents as observed from the study.
| Conclusion and recommendations|| |
There is a good knowledge of this procedure among pregnant women in the region. Most of the women believed that episiotomy should be selective and local anaesthesia should be administered prior to the procedure.
Health personnel and electronic media houses need to re-double their efforts on community enlightenment programmes on health-related issues to ensure the right information is communicated to the populace. Also efforts should be made to create more awareness on episiotomy among antenatal clients by inculcating it and other conditions in the health talks given to these women and to respond appropriately to their questions so as to allay their anxiety.
There is need for adequate counselling prior to episiotomy.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]