Primiparous women's preparedness and lived experiences of episiotomy at St. Mary's Hospital, Lacor, Gulu, Northern Uganda

Abstract

Introduction: Episiotomies are still widely performed globally with 40% of primiparous women at St. Mary’s Hospital, Lacor undergoing the procedure. There is a paucity of data on whether primiparous women understand the indications, consenting procedures, and their lived experiences thereafter and following discharge from the hospital. This study explored the primiparous women’s preparedness and lived experiences of episiotomy at St. Mary’s Hospital, Lacor. Methods: A phenomenological study in the Post-natal and Immunization Clinic of St. Mary’s Hospital, Lacor, was conducted among 20 primiparous women who had episiotomy during childbirth at the 6th week to 18 months of follow-up and six (6) health workers as Key informants (KIs). In-depth audio-recorded interviews for women and KI interviews for healthcare providers were conducted, transcribed verbatim, and analyzed manually using both deductive and inductive thematic techniques guided by the socio-ecological model (SEM) as the theoretical framework. Results: The study conducted in-depth interviews and key informant interviews from January to March 2024, with participants averaging 22 years of age. Most were married and had at least a secondary education. Primiparous women were not adequately prepared for episiotomy. Positive outcomes of episiotomy included successful delivery and enhanced sexual enjoyment, while negative outcomes included perineal pain, bleeding, emotional distress, prolonged healing, and painful intercourse. Inadequate anesthesia at the health facility level was a major concern. Conclusion: The study revealed gaps in Antenatal Care (ANC) education on episiotomy as women did not receive specific teachings on it and informed consent for episiotomy did not provide alternatives, benefits and risks, and affirmation for the procedure. Additionally, positive experiences such as successful childbirth and the procedure being perceived as safe compared to the cesarean section were noted, while perineal pain and painful sexual intercourse were the negative experiences. Recommendations: Comprehensive health education encompassing teachings on episiotomy should be practiced at the ANC unit for primigravidae. Facility-based checklist for obtaining informed consent on episiotomy should availed at the Maternity Unit. Continuous medical education should be given to all health workers in the obstetrics and gynecology department on episiotomy including the aspects of the technique, analgesia, and post-delivery care.