Journal Reading DELIVERY ROOM

A Reading on
EPISIOTOMY
In Partial Fulfillment of the

Requirements in NCM 207 – RLE
DELIVERY ROOM NURSING ROTATION
Submitted to:
MARIE VANESA Y. GAMBET, RN
Clinical Instructor
Submitted by
CHEYENNE MARI B. RODRIGUEZ, ST. N.
BSN 2C – Group 1 – Subgroup 4
September 28, 2021

Title
Knowledge and Attitude Regarding Episiotomy Wound Care Among Third

Trimester Primigravida Mothers
Bibliography
Kaur, J., Kumari, R., & Samuel, P. (2014). Knowledge and attitude regarding
episiotomy wound care among third trimester primigravida mothers.
International Journal of Obstetrics, Perinatal and Neonatal Nursing, 1(1),
12-21.
Summary
Motherhood is a wonder of creation and an event that is anticipated yet, at

the same time, can somehow be so enigmatic. Being a process that is
exceedingly complex and intricate, safe motherhood should be guaranteed by
prioritizing prompt provision of proper obstetric care. This initiative intends to
reduce maternal mortality by 50% within a decade, aiming to enhance the quality
of life for both the mother and the newborn.
The safe motherhood initiative encompasses episiotomy, introduced in the

1950s and has subsequently gained widespread acceptance for the purpose of
mitigating the risk of severe perineal tear, shortening the delivery, and preserving
the integrity of the pelvic floor. However, embedded in these indications is also
the prospect of hazards, including pain in immediate postpartum period, infected
wounds, and long-term dyspareunia from scarring. Considering this notion,
international institutions and professional societies have now recommended
episiotomy only when there is a definite clinical indication. Moreover, the WHO
also acknowledged the necessity of “positive childbirth experience”, where the
increased emphasis on women-centered outcome in clinical decision making
instigated a higher relevance for women’s experience, knowledge, and attitude
on episiotomy, especially on wound care.
Nursing care such as perineal toileting, perineal hygiene, and episiotomy
care is oriented towards achieving self-sufficiency for the patient. As the trend is
spearheading maternal health promotion, managing primary perineal care at
home can become an independent activity. The outcomes of episiotomy can be
markedly overwhelming, especially for primigravida mothers, stemming from the
imminent affliction induced by the surgical procedure itself as well as from the
general concept of responsibility and management during convalescence period
and subsequent parenthood. With the surge of “first times” and insufficient
firsthand experiences, it is extremely difficult for the mother to envision and grasp
the appropriate sentiment and response surrounding the whole course of action.
Consequently, their knowledge and attitude are affected to a great extent, as
they do not have a definite basis where they could anchor their outlook. In India,
majority of the gravida population have poor to moderate knowledge and fairly
favorable attitude on episiotomy procedure and wound care, being influenced by
their education, occupation, and income. Possessing little knowledge can make
women fearful of childbirth, clouding their ability to balance the benefits and harm
as well as understanding of the justification of the surgical procedure. There were
also contrasting attitudes towards the policy and idea around episiotomy,
ostensibly influenced by their preexisting knowledge. Some have clearly
supported the routine, viewing it as a requirement, especially for those who will
be undergoing vaginal delivery. They have also expressed that such procedure
would not cause critical complications as long as there is cautious movement and
consistent postpartum obstetric care. On the other hand, others have criticized
and deemed it as excessive, stating that it can be unnecessary when the
situation comes and conveying apprehension for the potential risks.
Reaction
I wholly agree with this article. First of all, the information it has presented
are indubitably factual while incorporating the experiences from the mother
themselves, validated by manifold other studies. Second of all, more importantly,
I concur on the emphasis on the viewpoint of primigravida mothers towards just
the general concept around episiotomy. This provides an opportunity to gauge on
a completely different perspective, considering that they lack the desired
experience to grasp on; therefore, perhaps, they are more prone to uncertainties
and trepidation, as opposed to multigravida mothers who already had a definite
comprehension of what actually occurs.
After carefully analyzing the journal, I realized that the outlook towards the
episiotomy procedure is considerably more polarizing than I have previously
thought. On one hand, several health institutions have discouraged, if not
prohibited, the conduct of such surgery. Statistics have presented that there is a
startling increase of the number of procedures performed in the hospitals despite
the recommendation. For years, episiotomy was thought to preclude extensive
perineal tears, recuperate better than natural tear, as well as preserve the tissue
reinforcing the pelvic floor. In the 1980s, what was once thought to be its
advantage were deliberately scrutinized, and questions about it began to surface.
It was ultimately unveiled that it is actually ineffectual in uncomplicated births,
which has been a contraindication all along. On the other hand, episiotomy is
also an undeniably critical procedure that not only expedites the complex process
of safe delivery and attenuates the ensuing intense discomfort, but it can also,
under graver circumstances, save both the mother and baby’s lives. This is why,
in the fullness of time, episiotomy is now performed on an individualized basis. It
is now only allowed when the clinical circumstances place the mother and the
infant at high risk. After all, no matter what the stance each mother stands with,
theirs and their child’s wellbeing should always be of utmost importance.
This article offers substantial and essential information that in turn renders
a positive impact not only to the readers but also to the encompassing society in
general. It provides knowledge not only on episiotomy itself but also the
surrounding insights, experiences, and viewpoints from the professional
community as well as the mothers themselves. Thus, this journal creates a
stepping stone for the community to hopefully acknowledge and penetrate
through the procedure’s actual impact to the nursing culture as well as to the
wellbeing and integrity of the patients. As much of a positive impact this journal
can offer, it can also have a negative impact. As it foregrounded the polarized
judgment and scrutiny regarding the nature of the episiotomy routine, it could
intimidate and dissuade the community, especially the gravida population, from
even considering the prospect during childbirth. As it also accentuated the
experiences, knowledge, and attitudes of the mothers, it may bring about the
undesirable realities and precariousness of such surgery during the inevitable.
This activity has presented substantial implications. Firstly, carrying out

journal reading imparts beginners the essential knowledge and mastery of
medical concepts. Superficially, it helps student nurses develop the ability to
research, read efficiently, apply ethical methods in acquiring related studies, and
analyze data. On a deeper note, journal reading and the chosen topic aids in
creating our insights and perspective, allowing us to reflect and relate it with our
own standpoint. Secondly, journal reading develops the student nurses’
information literacy skills. These help us utilize data to create conclusions and
recommendations, which are essential in the improvement of nursing research.
Appraising the awareness and realizations of this article, this guides the way for
future studies to be conducted that emphasize this disputed surgical procedure.
This would aid in further discovery and investigation of other contentious invasive
methods which possibly is still carried out abusively without proper governance.
Eventually, we would be able to evaluate and select a more reliable and benign
procedure that produces the most desirable consequences to the patient’s health
and wellbeing, even in the long run. Lastly, the knowledge and new perspective
the article has imparted becomes an integral part of nursing practice when the
circumstance calls. It offers a newfound appreciation and motivation to students
for their role as future nurses. Moreover, this journal reading hones our nursing
intuition and skills to be equipped when it comes to the actual work setting in the
delivery room. This would help student nurses conveniently and effectively utilize
and perform the necessary nursing process, nursing actions, or interventions,
especially when actually dealing with gravida patients, childbirth, and the
subsequent postpartum care in the near future as a full-fledged nurse.
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A Reading on

In Partial Fulfillment of the

DELIVERY ROOM NURSING ROTATION

September 28, 2021

Knowledge and Attitude Regarding Episiotomy Wound Care Among Third

Motherhood is a wonder of creation and an event that is anticipated yet, at

The safe motherhood initiative encompasses episiotomy, introduced in the

This activity has presented substantial implications. Firstly, carrying out

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