Frequency of Episiotomy and Perineal Injury in Home Births and Influencing Factors

Yıl 2025, Cilt: 8 Sayı: 1, 67 - 75, 26.03.2025

Menekşe Nazlı Aker , Emel Ay

https://doi.org/10.62425/esbder.1420052

Öz

Objective: Women may choose home birth to avoid medical interventions such as episiotomy, as midwife-assisted births involve fewer interventions and support the physiological birth process. The aim of this study is to examine perineal outcomes (episiotomy and perineal injury) in planned home births and the associated factors.
Methods: This descriptive study was conducted between August 2021 and January 2022. The sample consisted of 159 women. The data were collected by using the Personal Information Form and Satisfaction Scale (Visual Analog Scale-Satisfaction).
Results: Participants preferred home birth for reasons such as preserving privacy, avoiding IV oxytocin use, having their spouse present during labor, and preventing episiotomy. Intact perineum was observed in 33.3% of participants, while 17.0% underwent episiotomy, and 51.6% experienced perineal injury requiring suturing. Multiparity and flexible sacrum positions were associated with a higher rate of perineal integrity, while multiparity was also linked to a higher risk of perineal injury requiring suturing. Participants received midwifery support during home births and reported high levels of satisfaction with the care they received.
Conclusion: The rate of episiotomy and perineal injury was low in-home births. These results show that women's preference for home birth enables them to avoid medical interventions. Midwives and nurses are recommended to provide pregnant women with the necessary information to help them determine a safe place for childbirth.

Anahtar Kelimeler

episiotomy, perineal trauma, birth, home birth

Frequency of Episiotomy and Perineal Injury in Home Births and Influencing Factors

Öz

Objective: Women may choose home birth to avoid medical interventions such as episiotomy, as midwife-assisted births involve fewer interventions and support the physiological birth process. The aim of this study is to examine perineal outcomes (episiotomy and perineal injury) in planned home births and the associated factors.
Methods: This descriptive study was conducted between August 2021 and January 2022. The sample consisted of 159 women. The data were collected by using the Personal Information Form and Satisfaction Scale (Visual Analog Scale-Satisfaction).
Results: Participants preferred home birth for reasons such as preserving privacy, avoiding IV oxytocin use, having their spouse present during labor, and preventing episiotomy. Intact perineum was observed in 33.3% of participants, while 17.0% underwent episiotomy, and 51.6% experienced perineal injury requiring suturing. Multiparity and flexible sacrum positions were associated with a higher rate of perineal integrity, while multiparity was also linked to a higher risk of perineal injury requiring suturing. Participants received midwifery support during home births and reported high levels of satisfaction with the care they received.
Conclusion: The rate of episiotomy and perineal injury was low in-home births. These results show that women's preference for home birth enables them to avoid medical interventions. Midwives and nurses are recommended to provide pregnant women with the necessary information to help them determine a safe place for childbirth.

Anahtar Kelimeler

Episiotomy, perineal trauma, birth, home birth

Kaynakça

• ACOG. (2017). Planned home birth. Committee Opinion No. 697. American College of Obstetricians and Gynecologists. Obstet Gynecol, 129:e117–22. DOI: 10.1097/AOG.0000000000002024
• Aktaş, S., & Küçük Alemdar, D. (2024). Why mothers with midwifery-led vaginal births recommend that mode of birth: a qualitative study. Journal of Reproductive and Infant Psychology, 1-22. https://doi.org/10.1080/02646838.2024.2328765
• Bolten, N., de Jonge, A., Zwagerman, E., Zwagerman, P., Klomp, T., Zwart, J. J., & Geerts, C. C. (2016). Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands. BMC Pregnancy and Childbirth, 16(1), 329. https://doi.org/10.1186/s12884-016-1130-6
• Brokelman, R. B., Haverkamp, D., van Loon, C., Hol, A., van Kampen, A., & Veth, R. (2012). The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty. Eur Orthop Traumatol, 3, 101–105 https://doi.org/10.1007/s12570-012-0100-3
• Çankaya, S., Tezgören, E. & Dikmen, H.A. (2024). The effects of the intrapartum care model given in line with the recommendations of the World Health Organization (WHO) on the mother’s maternal behavior towards her baby, breastfeeding self-efficacy, breastfeeding success, and hospital discharge readiness: a randomized controlled trial. Arch Gynecol Obstet, 310, 3009–3027 https://doi.org/10.1007/s00404-024-07844-0
• Edqvist, M., Blix, E., Hegaard, H. K., Ólafsdottir, O. Á., Hildingsson, I., Ingversen, K., Mollberg, M., & Lindgren, H. (2016). Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth. BMC Pregnancy and Childbirth, 16(1), 196. https://doi.org/10.1186/s12884-016-0990-0
• Erbaydar, N. (2021). Mother-friendly hospital programme of Turkey: national intervention to improve the quality of maternity services. East Mediterr Health J, 27(2), 202-210. https://doi.org/10.26719/emhj.20.138
• Frohlich, J., & Kettle, C. (2015). Perineal care. BMJ Clinical Evidence, 1401, 1-23.
• Galera-Barbero, T. M., & Aguilera-Manrique, G. (2022). Experience, perceptions and attitudes of parents who planned home birth in Spain: A qualitative study. Women and Birth, 35(6),602-611. https://doi.org/https://doi.org/10.1016/j.wombi.2022.01.004
• Goh, R., Goh, D., & Ellepola, H. (2018). Perineal tears – A review. Australian Journal for General Practitioners, 47(1-2),35-38. doi:10.31128/AFP-09-17-4333
• Hailemeskel, S., Alemu, K., Christensson, K., Tesfahun, E., & Lindgren, H. (2022). Midwife-led continuity of care increases women's satisfaction with antenatal, intrapartum, and postpartum care: North Shoa, Amhara regional state, Ethiopia: A quasi-experimental study. Women and birth: Journal of the Australian College of Midwives, 35(6), 553–562. https://doi.org/10.1016/j.wombi.2022.01.005
• Hotun Şahin, N., Yıldırım, G., & Aslan, E. (2007). Evaluating the second stages of deliveries in a maternity hospital. Turkiye Klinikleri J Gynecol Obst, 17(1), 37-43.
• HUIPS. (2019). 2018 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget and TÜBİTAK. http://www.openaccess.hacettepe.edu.tr:8080/xmlui/handle/11655/23345
• ICM. (2017). Position Statement Home Birth. https://internationalmidwives.org/resources/home-birth/
• Jiang, H., Qian, X., Carroli, G., & Garner, P. (2017). Selective versus routine use of episiotomy for vaginal birth. The Cochrane Database of Systematic Reviews, 2(2), CD000081-CD000081. https://doi.org/10.1002/14651858.CD000081.pub3
• Karaçam, Z., Ekmen, H., Calişır, H., & Seker, S. (2013). Prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, wound healing 3 weeks postpartum, in Turkey: A prospective follow-up study. Iran J Nurs Midwifery Res, 18(3), 237-245.
• Kartal, B., Kızılırmak, A., Calpbinici, P., & Demir, G. (2017). Retrospective analysis of episiotomy prevalence. J Turk Ger Gynecol Assoc, 18(4), 190-194. https://doi.org/10.4274/jtgga.2016.0238
• Kemp, E., Kingswood, C. J., Kibuka, M., & Thornton, J. G. (2013). Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews, 1, CD008070. https://doi.org/10.1002/14651858.CD008070.pub2
• Kumru, P., & Topuzoğlu, A. (2019). A current overview of planned home deliveries in the Wirld; rısks and benefits. Zeynep Kamil Tıp Bülteni, 50(2), 82-89. https://doi.org/https://doi.org/10.16948/zktipb.531769
• Leon-Larios, F., Nuno-Aguilar, C., Rocca-Ihenacho, L., Castro-Cardona, F., & Escuriet, R. (2019). Challenging the status quo: Women's experiences of opting for a home birth in Andalucia, Spain. Midwifery, 70, 15-21. https://doi.org/https://doi.org/10.1016/j.midw.2018.12.001
• Lindgren, H. E., Brink, Å., & Klingberg-Allvin, M. (2011). Fear causes tears - Perineal injuries in home birth settings. A Swedish interview study. BMC Pregnancy and Childbirth, 11(1), 6. https://doi.org/10.1186/1471-2393-11-6
• Liu, Y., Li, T., Guo, N. et al. (2021). Women’s experience and satisfaction with midwife-led maternity care: a cross-sectional survey in China. BMC Pregnancy Childbirth 21, 151. https://doi.org/10.1186/s12884-021-03638-3
• Lopes, G. A., Leister, N., & Riesco, M. L. G. (2019). Perineal care and outcomes in a birth center. Texto & Contexto-Enfermagem, 28, e20190168. https://doi.org/10.1590/1980-265X-TCE-2018-0168.
• Nabirye, R. C., Mbalinda, S. N., Epuitai, J., Nawagi, F., Namyalo, S., Nove, A., ... & Homer, C. S. (2024). Perceptions of quality of care in Midwife-led Birth Centres (MLBCs) in Uganda: Why do women choose MLBCs over other options?. Women and Birth, 37(4), 101612.
• Naylor Smith, J., Taylor, B., Shaw, K., Hewison, A., & Kenyon, S. (2018). ‘I didn’t think you were allowed that, they didn’t mention that.’ A qualitative study exploring women’s perceptions of home birth. BMC Pregnancy and Childbirth, 18(1), 105. https://doi.org/10.1186/s12884-018-1733-1
• NHS. (2024). Where to give birth: the options. https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/
• Nove, A., Friberg, I. K., de Bernis, L., McConville, F., Moran, A. C., Najjemba, M., ... & Homer, C. S. (2021). Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. The Lancet Global Health, 9(1), e24-e32, doi:10.1016/S2214-109X(20)30397-1
• Okumuş, F. (2017). Birth experiences of primiparous Turkish women public and private hospitals. JAM, 4(1), 35-50.
• Olsen, O., & Clausen, J. A. (2023). Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database of Systematic Reviews, 3, CD000352. DOI: 10.1002/14651858.CD000352.
• Prates, L. A., Timm, M. S., Wilhelm, L. A., Cremonese, L., Oliveira, G., Schimith, M. D., & Ressel, L. B. (2018). Being born at home is natural: care rituals for home birth. Rev Bras Enferm, 71(suppl 3), 1247-1256. https://doi.org/10.1590/0034-7167-2017-0541
• Rodrigues, S., Silva, P., Agius, A., Rocha, F., Castanheira, R., Gross, M., & Calleja-Agius, J. (2019). Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth? Materia Socio-Medica, 31(1), 25-30. https://doi.org/10.5455/msm.2019.31.25-30
• Rodríguez-Garrido, P., Pino-Morán, J. A., & Goberna-Tricas, J. (2020). Exploring social and health care representations about home birth: An Integrative Literature Review [https://doi.org/10.1111/phn.12724]. Public Health Nursing, 37(3), 422-438. https://doi.org/https://doi.org/10.1111/phn.12724
• Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 4, CD004667. DOI: 10.1002/14651858.CD004667.
• Sassine, H., Burns, E., Ormsby, S., & Dahlen, H. G. (2021). Why do women choose homebirth in Australia? A national survey. Women and Birth, 34(4), 396-404. https://doi.org/https://doi.org/10.1016/j.wombi.2020.06.005
• Singh, S., Thakur, T., Chandhiok, N., & Dhillon, B. S. (2016). Pattern of episiotomy use & its immediate complications among vaginal deliveries in 18 tertiary care hospitals in India. The Indian Journal of Medical Research, 143(4), 474-480. https://doi.org/10.4103/0971-5916.184304
• Skrondal, T. F., Bache-Gabrielsen, T., & Aune, I. (2020). All that I need exists within me: A qualitative study of nulliparous Norwegian women's experiences with planned home birth. Midwifery, 86, 102705. https://doi.org/https://doi.org/10.1016/j.midw.2020.102705
• Smith, L. A., Price, N., Simonite, V., & Burns, E. E. (2013). Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy and Childbirth, 13(1), 59. https://doi.org/10.1186/1471-2393-13-59
• T.C. Sağlık Bakanlığı. (1997). Sağlık Kabinlerinin Açılışı ve İşleyişi Hakkında Genelge (1997-3). Resmî Gazete.
• T.C. Sağlık Bakanlığı. (2008). Anne Ölümleri Hakkında Genelge. https://www.saglik.gov.tr/TR-11122/anne-olumleri-hakkinda-genelge.html
• T.C. Sağlık Bakanlığı. (2023). Anne Dostu Hastane Programı. https://hsgm.saglik.gov.tr/tr/programlar-2/anne-dostu-hastane-programi.html
• T.C. Sağlık Bakanlığı. (2025). Normal Doğum Eylem Planı. https://sggm.saglik.gov.tr/TR-106002/dogal-olan-normal-dogum.html
• TÜİK. (2021). Doğum İstatistikleri, 2020. https://data.tuik.gov.tr/Bulten/Index?p=Dogum-Istatistikleri-2020-37229
• Wewers, M. E., & Lowe, N. K. (1990). A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing & Health, 13(4), 227-236.
• WHO. (2018). WHO recommendations: intrapartum care for a positive childbirth experience. http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1
• Wright, A., Nassar, A.H., Visser, G., Ramasauskaite, D., & Theron, G. (2021). FIGO good clinical practice paper: management of the second stage of labor. Int. J. Gynecol. Obstet., 152, 172-181. https://doi.org/10.1002/ijgo.13552