|Year : 2018 | Volume
| Issue : 7 | Page : 865-869
Knowledge and perception of episiotomy among women attending antenatal clinic in a secondary health facility in North-West Nigeria
MS Ibrahim1, B Zakaria2, BB Lawal3
1 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
2 Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria
3 University Health Services, Ahmadu Bello University, Zaria, Nigeria
|Date of Acceptance||22-May-2018|
|Date of Web Publication||09-Jul-2018|
Dr. M S Ibrahim
Department of Community Medicine, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Episiotomy is a common surgical procedure experienced by women worldwide to ease labor and improve its outcome. However, it could influence the use of delivery services because of its associated complications. The study assessed knowledge and perception of episiotomy among antenatal clinic (ANC) attendees. Methods: It was a cross-sectional study conducted among 218 women attending ANC in a secondary health facility in Northwestern Nigeria. Data were collected using a structured, interviewer-administered questionnaire and were analyzed using IBM SPSS Statistics 20. Results: The mean age of women attending ANC was 24.2 ± 6.6 years, and 31 (14.2%) of them had had an episiotomy in the past. A majority of them were aware of episiotomy (87.6%) and had good knowledge (83.5%) and good perception (77.5%) of it. In addition, a majority (89.0%) were willing to deliver at the facility even if episiotomy would be given during labor. Knowledge of episiotomy showed statistically significant association with only a history of previous delivery while perception did not show statistically significant association with any of the independent variables. Conclusions: Awareness and knowledge of episiotomy among women attending ANC were high and perception of it was generally good. The major factor associated with the knowledge of episiotomy was a history of previous delivery. Effort should be channeled toward improving awareness and knowledge on episiotomy among intending mothers, and health workers should always ensure that women are adequately informed and counseled before an episiotomy is given to them.
Keywords: Episiotomy, knowledge, Northwest Nigeria, perception
|How to cite this article:|
Ibrahim M S, Zakaria B, Lawal B B. Knowledge and perception of episiotomy among women attending antenatal clinic in a secondary health facility in North-West Nigeria. Niger J Clin Pract 2018;21:865-9
|How to cite this URL:|
Ibrahim M S, Zakaria B, Lawal B B. Knowledge and perception of episiotomy among women attending antenatal clinic in a secondary health facility in North-West Nigeria. Niger J Clin Pract [serial online] 2018 [cited 2022 Jan 24];21:865-9. Available from: https://www.njcponline.com/text.asp?2018/21/7/865/236153
| Introduction|| |
Episiotomy is one of the most common surgical procedures performed on women worldwide. It is more common in hospital delivery and among primigravidae. Reported rates of episiotomy range from as low as 9.7% in Sweden to as high as 100% in Taiwan, with developing countries having the highest rates. Episiotomy is useful in situ ations such as managing the abnormal progression of the second stage of labor due to tight perineum, assisted vaginal delivery, and shoulder dystocia as well as hastening the second stage of labor and reducing some of the complications of the delivery process. However, it has some complications which include perineal pain, asymmetry, infection, partial dehiscence, skin tags, hemorrhage, and extension of the incision.,, While some studies have reported that liberal or routine use of episiotomy is not necessarily protective and may even cause pelvic floor relaxation,, more recent evidence show that episiotomy protects against pelvic floor disorders.,
Studies have shown that invasive obstetric interventions are negatively associated with satisfaction with delivery services. Knowledge of benefits and complications of obstetrics interventions including episiotomy is necessary to enable a woman to make informed decision to either accept or reject the intervention. Given the aversion associated with episiotomy, it is imperative to understand what women know about episiotomy and their perception of it.
The most studies conducted in Nigeria have assessed knowledge and perception of episiotomy among pregnant women in tertiary health facilities where the rate of episiotomy is generally known to be high., Much is not known about the knowledge and perception of episiotomy among pregnant women in lower level health facilities in Nigeria where there are health workers with a lower level of qualification. This study assessed knowledge and perception of episiotomy among women attending antenatal care (ANC) in a secondary health facility in a semi-urban community in North-Western Nigeria.
| Methods|| |
The study was conducted in General Hospital Giwa, which is the only secondary health facility located in Giwa, a semi-urban community in Giwa local government area (LGA) of Kaduna State. The residents of Giwa are mostly Hausa/Fulani and their major occupation is farming and trading. General Hospital Giwa has four departments: Obstetrics and gynecology, medicine, surgery, and pediatrics. It offers outpatient, inpatient, and 24 h emergency services. It has a 130-bed space capacity. The obstetrics and gynaecology department provides antenatal, delivery, postnatal, and emergency obstetrics services. The ANC has an average of 375 client turnover per month. The average delivery rate is 90–150 deliveries per month. Deliveries are routinely supervised by nurses who also give the episiotomy except when there are complications during which the doctors are invited to manage.
The study was a cross-sectional study conducted among ANC attendees in the General Hospital. A minimum sample size of 218 pregnant women was estimated using the Lemeshow and Lwanga approach  taking proportion of pregnant women with good perception of episiotomy to be 40.4%, standard normal deviate at 95% confidence interval to be 1.96, error margin of 0.05%, and nonresponse rate of 10%. Pregnant women aged 18 years and above in the second- and third-trimester were included in the study. The respondents were selected using systematic sampling technique and interviewed. A sampling interval of two was calculated. From the list of ANC attendees for a day, the initial selection is done between the first two attendees on the list following which every next second attendee is selected until the list is exhausted. This process was on the three clinic days for four weeks to reach the minimum sample size. Before the interview, verbal informed consent was obtained from each pregnant woman after explaining the objectives and nature of the study.
Data were collected using a structured, interviewer-administered questionnaire containing both open- and close-ended questions, adopted from the previous studies.,, The questionnaire had sections on sociodemographic profile, knowledge, and perception of episiotomy. It was pretested by administering it to 40 women who met the eligibility criteria at General Hospital Hunkuyi, in a different but similar Kudan LGA. There was no significant adjustment necessary following the pretest. The data collection was done by a team of four final year undergraduates. The data collectors were trained on the objectives of the research and taken through all the questions and possible responses one at a time. The data obtained were analyzed using the IBM SPSS Statistics 20. Frequencies and percentages were computed for categorical variables (sociodemographic variables, knowledge, and perception), and the associations between them and knowledge and perception of episiotomy were assessed using Chi-square test (or Yate's Chi-square where applicable) with P < 0.05 considered statistically significant. The results were presented as tables. Both knowledge and perception were assessed using a set of eight questions each. In each case, a score of one was assigned to each correctly answered question and zero for a wrongly answered question, giving a minimum possible score of zero and a maximum possible score of eight. A total score of 0–3 was graded as poor, 4–5 graded as fair, and 6–8 graded as good perception.
| Results|| |
A total of 218 pregnant women were recruited, and all were successfully interviewed. Their mean age was 24.2 ± 6.6 years. Of the total pregnant women, 200 (91.7%) were Hausa, 203 (93.1%) were Muslim, 217 (99.5%) were married, 116 (53.2%) were traders, and 196 (89.9%) earned <1 dollar/day. About 90 of them (41.3%) had only Qur'anic education, only 9 (4.1%) had attained tertiary education. About 15 (6.9%) of the pregnant women were primigravidae [Table 1].
A total of 191 (87.6%) of them were aware of episiotomy, and 194 (89.0) were willing to deliver at the hospital even if episiotomy would be given during labor. Only 14 (14.2%) had had an episiotomy in the past. A total of 182 (83.5%) of the respondents had good knowledge of episiotomy, and only 27 (12.4%) had poor knowledge. Similarly, 169 (77.5%) had a good perception of episiotomy [Table 2].
|Table 2: Knowledge and perception of episiotomy among pregnant women studied|
Click here to view
Knowledge of episiotomy showed statistically significant association with a history of previous delivery, but no statistically significant association with age, level of education, occupation, and having an episiotomy in the past [Table 3]. There was no statistically significant association between perception of episiotomy and all the independent variables tested [Table 4].
|Table 3: Knowledge of episiotomy by age, level of education, previous delivery, and occupation|
Click here to view
|Table 4: Perception of episiotomy by age, level of education, previous delivery, and occupation|
Click here to view
| Discussion|| |
The levels of awareness and knowledge of episiotomy were high among the pregnant women, similar to the findings in Kano in Northern Nigeria  and Alberta in Canada, but slightly higher than that in Calabar in Southern Nigeria (61.0%). The high awareness and knowledge of episiotomy observed in this study could be as a result of number of previous deliveries experiences of the majority of the participants. A similar association between knowledge of episiotomy and number of previous deliveries has also been reported by another researcher in Hong Kong. It can be argue that since pregnant women are not necessarily counseled or informed about episiotomy before the procedure is done,,, the previous history of deliveries might not necessarily be associated with the high awareness and knowledge of episiotomy. This could explain the apparent lack of statistically significant association that was observed between knowledge of episiotomy and history of having an episiotomy in the past in this study.
The proportion of women who had an episiotomy in the past was lower than what was previously reported from Ahmadu Bello University Teaching Hospital  and Aminu Kano Teaching Hospital, both in Northern Nigeria as well as in Abia State University in Southern Nigeria. The lower prevalence of episiotomy recorded in this study when compared to those of Zaria, Kano, and Abia could be explained by the fact that this study was conducted in a secondary health facility.,, This is because episiotomy is more likely to be given to women during delivery in tertiary health facilities and by health workers with higher level qualifications.,
Studies have reported that the most women are given episiotomy without prior information or counseling, and the wound might even heal without their awareness of its presence.,, As such a woman could have an episiotomy during a delivery without her being aware of it, and probably taking its pain to be part of the normal pain of labor, and if complications develop afterward, they might be seen as a complication of the delivery.
Majority of the pregnant women in this study had a good perception of episiotomy. This is similar to the finding from Kano in Nigeria, Alberta in Canada, and São Paulo in Brazil where the majority of the respondents were also reported to have had a good perception of episiotomy.,,
The lack of statistically significant association between perception of episiotomy and age, parity, and educational status observed in this study has been reported previously. The reason for the lack of association between perception and number of previous deliveries could also be explained by the reason given above for the lack of association between knowledge of episiotomy and number of previous deliveries.
This study has a few limitations. It relied on the respondents for history of episiotomy, which some of them could have experienced without volunteering the information. Response from the respondents remains the most reliable means of obtaining such information considering that record keeping in most secondary health facilities is poor. In addition, it is possible that some of the ANC attendees did not have their previous delivery in the same facility.
| Conclusions|| |
Awareness and knowledge of episiotomy were high, and perception of it was generally good. A Majority were willing to deliver at the hospital even if episiotomy would be given during labor. The major determinants of the knowledge of episiotomy were a history of previous delivery, and there was no statistically significant association between the perception of episiotomy and all the independent variables tested. There is need to increase effort at improving awareness and knowledge on episiotomy among ANC clients by including it in the health talks given during ANC visits. Similarly, it is important that women are adequately informed and counseled before an episiotomy is given to them.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Trinh AT, Khambalia A, Ampt A, Morris JM, Roberts CL. Episiotomy rate in vietnamese-born women in Australia: Support for a change in obstetric practice in viet nam. Bull World Health Organ 2013;91:350-6.
Sule ST, Shittu SO. Puerperal complications of episiotomies at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. East Afr Med J 2003;80:351-6.
Graham ID, Carroli G, Davies C, Medves JM. Episiotomy rates around the world: An update. Birth 2005;32:219-23.
American College of Obstetricians-Gynecologists. ACOG practice bulletin. Episiotomy. Clinical management guidelines for obstetrician-gynecologists. Number 71, April 2006. Obstet Gynecol 2006;107:957-62.
Inyang-Etoh EC, Umoiyoho A. The practice of episiotomy in a university teaching hospital in Nigeria: How satisfactory ? Int J Med Biomed Res 2012;1:68-72.
Figueiredo G, Barbieri M, Gabrielloni MC, Araújo ES, Henrique AJ. Episiotomy: Perceptions from adolescent puerperae. Invest Educ Enferm 2015;33:365-73.
Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E, Guaschino S, et al.
The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 2004;103:669-73.
Röckner G, Jonasson A, Olund A. The effect of mediolateral episiotomy at delivery on pelvic floor muscle strength evaluated with vaginal cones. Acta Obstet Gynecol Scand 1991;70:51-4.
Bertozzi S, Londero AP, Fruscalzo A, Driul L, Delneri C, Calcagno A, et al.
Impact of episiotomy on pelvic floor disorders and their influence on women's wellness after the sixth month postpartum: A retrospective study. BMC Womens Health 2011;11:12.
Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: Effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol 2012;119:233-9.
Green JM, Coupland VA, Kitzinger JV. Expectations, experiences, and psychological outcomes of childbirth: A prospective study of 825 women. Birth 1990;17:15-24.
Lívia A, Sousa R, Maria A, Pereira M, Claudia M, Hipólito V, et al
. Meanings assigned by puerperal women to episiotomy. Int Arch Med 2016;9:1-7.
Breitkreuz L. Characteristics, Knowledge and Perceptions of Women Who Receive Episiotomy. Edmonton, Alberta, Canada. University of Canada;1998.
Lemeshow S, Hosmer DW, Klar J, Lwanga SK, WHO, editors. Adequacy of Sample Size in Health Studies. 1st
ed. Chichester, England: John Wiley & Sons; 1990.
Abubakar MY, Suleiman MM. Perception of episiotomy among pregnant women in Kano, North-Western Nigeria. Niger J Basic Clin Sci 2015;12:25-9. [Full text]
Chigbu B, Onwere S, Aluka C, Kamanu C, Adibe E. Factors influencing the use of episiotomy during vaginal delivery in South Eastern Nigeria. East Afr Med J 2008;85:240-3.
Lam KW, Wong HS, Pun TC. The practice of episiotomy in public hospitals in Hong Kong. Hong Kong Med J 2006;12:94-8.
Al-Ghammari K, Al-Riyami Z, Al-Moqbali M, Al-Marjabi F, Al-Mahrouqi B, Al-Khatri A, et al.
Predictors of routine episiotomy in primigravida women in Oman. Appl Nurs Res 2016;29:131-5.
[Table 1], [Table 2], [Table 3], [Table 4]