Towards respectful obstetric care
DOI:
https://doi.org/10.56294/nds2024104Keywords:
episiotomy, informed consent, vaginal deliveries, women's autonomy, humanised careAbstract
Episiotomy was a common procedure in vaginal deliveries for decades, performed to prevent maternal complications. However, recent research has questioned its effectiveness and safety, promoting a more restrictive, evidence-based approach. It was found that routine use did not significantly reduce severe perineal tears or shorten the second stage of labour, and in some cases led to major complications. Factors associated with its practice were also identified, such as primiparity and the use of oxytocin, and the importance of informed consent was emphasised. From a clinical and ethical perspective, it was recommended that it should only be performed when strictly necessary, always prioritising respect for women's autonomy and humanised care.
References
1. Aguiar BM, Silva TPRD, Pereira SL, et al. Factors associated with the performance of episiotomy. Rev Bras Enferm. 2020;73(suppl 4):e20190899. doi:10.1590/0034-7167-2019-0899.
2. Alexander JW, Karantanis E, Turner RM, Faasse K, Watt C. Patient attitude and acceptance towards episiotomy during pregnancy before and after information provision: a questionnaire. Int Urogynecol J. 2020;31(3):521-8. doi:10.1007/s00192-019-04003-x.
3. Bączek G, Rychlewicz S, Sys D, Rzońca P, Teliga-Czajkowska J. Episiotomy for medical indications during vaginal birth—retrospective analysis of risk factors determining the performance of this procedure. J Clin Med. 2022;11(15):4334. doi:10.3390/jcm11154334.
4. Hartinah A, Usman AN, Sartini, et al. Care for perineal tears in vaginal delivery: an update for midwife. Gac Sanit. 2021;35(Suppl 2):S216-20. doi:10.1016/j.gaceta.2021.10.024.
5. He S, Jiang H, Qian X, Garner P. Women's experience of episiotomy: a qualitative study from China. BMJ Open. 2020;10(7):e033354. doi:10.1136/bmjopen-2019-033354.
6. Klein MC, Kaczorowski J. Routine use of episiotomy with forceps should not be encouraged. CMAJ. 2020;192(8):E190. doi:10.1503/cmaj.74132.
7. Koh LM, van Roon Y, Pradhan A, Pathak S. Impact of the EPISCISSORS-60 mediolateral episiotomy scissors on obstetric anal sphincter injuries: a 2-year data review in the United Kingdom. Int Urogynecol J. 2020;31(9):1729-34. doi:10.1007/s00192-019-04201-7.
8. MacLellan J, Webb SS, Byrne C, et al. Informed consent in episiotomy: co-analysis with midwives and distillation of best practice. Birth. 2023;50(4):773-80. doi:10.1111/birt.12721.
9. Radnia N, Khansari S, Jiriaei N, Hosseini SA, Salemi L, Hamoon M. The relationship between perineal size and episiotomy during delivery. J Med Life. 2022;15(11):1379-83. doi:10.25122/jml-2021-0390.
10. Sultan AH, de Leeuw JW. Episiotomy and operative vaginal delivery: do we need more evidence? BJOG. 2021;128(10):1672-3. doi:10.1111/1471-0528.16783.
11. Tantengco OAG, Velayo CL. Episiotomy practice and perineal trauma in the Philippines. Lancet Reg Health West Pac. 2022;19:100381. doi:10.1016/j.lanwpc.2022.100381.
12. Zhang D, Bo K, Montejo R, et al. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: systematic review and meta-analysis of randomized clinical trials. Acta Obstet Gynecol Scand. 2024;103(6):1015-27. doi:10.1111/aogs.14744.
Published
Issue
Section
License
Copyright (c) 2024 Agustina Campo (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.