KVINNORS UPPLEVELSER AV EPISIOTOMI En systematisk litteraturöversikt

Abstract

Background: Episiotomy is an incision in the vaginal opening and perineum during vaginal delivery to accelerate or facilitate the delivery. Indications for episiotomy can be threatened fetal asphyxia, increased risk of extensive vaginal rupture or in vacuum assisted deliveries. It is a part of the midwife’s area of expertise to conduct and suture episiotomies. According to WHO restrictive use of episiotomy should be preferred. Women who give birth without interventions are generally more satisfied with their deliveries. A negative experience can affect women’s reproductive health. Aim: To illustrate women’s experiences of episiotomy with a systematic literature review. Method: A systematic literature review based on qualitative studies with a total of 541 women included was conducted. Data collection was conducted in the databases PubMed and CINAHL. The included data was analyzed according to the nine steps presented by Bettany Saltikov and McSherry. Results: Thirteen qualitative articles published between 2018-2025 were included. Two main categories were identified: Experiences of decision making and participation regarding episiotomy and To live with the consequences of episiotomy – body, pain and future choices. The studies illustrate lacking information and consent before episiotomy. Obstetric violence was also highlighted. Postpartum was pain from the incision illustrated which affected breastfeeding, attachment, relationships, body image, sexual health and views on future pregnancies and deliveries. The need for individualised aftercare of episiotomy was highlighted. Conclusion: The birth experience is affected by the possibility of getting information and to be able to give consent to an episiotomy. It is a human right to receive information and to be able to participate in decisions over one’s own body. Women in the studies describe their experiences whenever this is not followed. Pain, lack of information and follow up is experienced. Working according to a woman-centred care approach counteract negative experiences associated with episiotomy.