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Real world research

Iranian women's experiences of the episiotomy consent process: a qualitative study

02 February 2023
Research
02 February 2023
Volume 31 · Issue 2

Abstract

Background

Knowledge of the benefits and complications of interventions related to medical procedures, such as episiotomy, enables women to make informed decisions regarding these interventions. This study investigated women's experiences of the episiotomy consent process in Iran.

Methods

This qualitative study gathered data from 20 women through in-depth semi-structured interviews. The participants were selected from hospitals, health centers and gynecology clinics in Tehran. Content analysis was used to establish themes from the gathered data.

Results

The participants' experiences showed that they felt that their needs were not met and that they were excluded from decision making regarding their birth.

Conclusions

Women were excluded from decision making and their unmet needs presented ethical challenges in the performance of episiotomy procedures. Neglecting women's expectations, inducing absolute trust in obstetricians or midwives and failing to obtain informed consent paved the way for forced episiotomies. Proper education and obtaining informed and voluntary consent may facilitate women's rights being respected.

In 1950, episiotomy was introduced as a surgical technique to reduce the risk of severe perineal tears, shorten the duration of birth and prevent damage to the pelvic floor (He et al, 2020). However, this technique can result in postpartum pain, wound site infection and long-term dyspareunia (Muhleman et al, 2017). The benefits of routine episiotomy have been a subject of controversy (Muhleman et al, 2017), and clinical guidance and professional communities currently recommend episiotomy only when there are clinical indications (American College of Obstetricians and Gynecologists, 2006; Royal College of Obstetricians and Gynecologists, 2015; World Health Organization, 2018a; National Institute for Health and Care Excellence, 2019). Despite these recommendations, the rate of episiotomy in vaginal births remains high in some countries and has been reported in 97% of primiparous women in Iran (Kajoye Shirazie et al, 2009; Cunningham et al, 2010).

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Decision making
Episiotomy
Experiences
Informed consent