The unkindest cut women never forget

News article 31 Jul 2020

A “psychological shadow” is how women describe the long term effect of the cut made by doctors in the skin and vagina during childbirth. This operation, called an episiotomy, caused in some women considerable pain in the following months, difficulty breast feeding, and misery. Siyuan He, Hong Jiang, and Xu Qian interviewed women after the procedure and carefully documented their views in a recent publication, as part of a long-standing collaboration with Professor Paul Garner at the Centre for Evidence Synthesis in Global Health at LSTM.

“There is a dearth of research on women’s views on this procedure worldwide”, points out Xu Qian, Professor and Head of Department in maternal and child health at Fudan University. “When we were working on the Cochrane review of episiotomy three years ago, we sought such papers and found none. The Cochrane review did not demonstrate any medical benefits of routine episiotomy, so it is particularly important to explore women’s preferences, as before this study an estimated 7.3 million episiotomies were performed in China every year”.

The findings from this study were extraordinary. The authors interviewed, sampled, and spoke in depth with 30 women. Some did not know what the procedure was until it had happened or were told by other women just after they had delivered. The impact on them physically was marked. Whilst some healing was uneventful, many described pain, constipation, difficulty breast feeding, and long-term anxiety about the damage to their organs and the damage to their confidence and sexuality.

Siyuan He and Hong Jiang explained: “there were two words that we struggled to find a translation in English. One was “psychological shadow” ( 心理阴影) which reflects the impact of the operation on women, a sense of dread and worry about the future-like the experience of war or a tumultuous personal event. The other word related to women not complaining about the pain to their family and friends. They were worried would be regarded as “low-tolerant” (娇气) – a pejorative personality trait showing weakness of character. So, women just suffered alone”.

“In the UK, the procedure was commonplace years ago as part of medicalised care but is now less frequent” commented LSTM’s Paul Garner. “It is staggering there is so little formal research looking at the impact of this procedure on women’s lives. Particularly important was how some words did not translate into English. Identifying them and describing them carefully gives this research a richness and resonance. It’s really a procedure doctors should avoid if at all possible”.

He S, Jiang H, Qian X, Garner P. Women’s experience of episiotomy: a qualitative study from China. BMJ Open 2020;10:e033354. doi: 10.1136/bmjopen-2019-033354

This publication is associated with the Research, Evidence and Development Initiative (READ-It). READ-It (project number 300342-104) is funded by UK aid from the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies.

Lead author team: School of Public Health, Fudan University, Shanghai