Midwives' perspectives regarding episiotomy practice in Kurdistan region/Iraq


  • Safiya Sabri Piro School of nursing, faculty of medical sciences, University of Duhok, Duhok, Iraq.
  • Hamdia Mirkhan Ahmed Department of maternity nursing, college of nursing, Hawler Medical University, Erbil, Iraq.




Episiotomy, Midwives, Kurdistan, Iraq


Background and objective: Local professional norms, experiences in tainting, and individual provider preference may lead to wide practice variation in rate and practice of episiotomy by midwives. The aim of this study was to find out the midwives' perspectives regarding practicing of episiotomy in three main cities of Kurdistan region/Iraq. Methods: A cross-sectional, descriptive study was conducted on 53 midwives working in delivery room in three maternity teaching hospitals in the three biggest cities of Kurdistan Region of Iraq. A questionnaire was constructed for the purpose of the study and data were collected by interview with midwives. F test and Chi-square test were used for analyzing the data. Results: The majority (88.7%) of midwives thought that the rate of episiotomy were high in their hospitals that were attributed to five factors; maternal (77.35%), fetal (39.62%), midwives (37.73%), obstetricians (30.18%) and hospital policy and health system (20.75%). The opinion of midwives regarding how to decrease the rate of episiotomy included improving midwifery care during delivery (77.35%), reforming health system (60.37%), reforming hospital policy (50.94%) and improving maternal care during pregnancy (26.41%). Conclusion: Taking into consideration the midwives' perspectives and views regarding episiotomy and providing training courses may help in decreasing the rate of episiotomy and its practice in correct way in Kurdistan's maternity hospitals.


Metrics Loading ...


Pairman S, Tracy S, Thorogood C, Pincombe J. Midwifery: preparation for practice. 2nd ed. Sydney: Elsevir; 2010. 551

Fraser D, Cooper M. Myles Textbook for Midwives. 15th ed Churchill Livingstone. Edinburgh; 2009. 523

Thacker B, Banta H. Benefits and risk of episiotomy: An interpretative review of the English literature (1860-1980). Obstet Gynacol 1983; 38:322-8.

Fernandes S, Benjamin E, Edwards G. Using evidence to reduce the rate of episiotomy in a Dubai hospital. Evidence Based Midwifery 2009; 7(2):60-3.

Brown S, Lumley J. Maternal health after childbirth: results of an Australian population survey. BJOG 1998; 105:156-61.

Goldberg J, Holtz D, Hyslop T, Tolosa J. Has the use of routine episitomy decreased? Examination of episiotomy rates from 1983 to 2000. The American College of Obstetricians and Gynecologists 2002; 99(3):395-400.

Viswanathan M, Hartmann K, Palmieri R, Lux L, Swinson T, Lohr K, et al. The use of episiotomy in obestetrical care: A systematic review. AHRQ Evidence Report Summaries; 2005.

Rashid A, Ali R. Assessment of nurse-midwives' knowledge and practices toward second stage of labor. Iraqi Sci J Nursing 2010; 23:15-26.

Samuels M, Samuels N. The new pregnancy. USA: Mike samules and Nancy Samuels; 1996.

- Teckla N, Omoni G, Mwaura J, Omuga B. Evaluation of evidence-based episiotomy practice by midwives. AJM 2010; 4(2):80-7.

Henriksen TB, Bek KM, Hedegaard M, Secher NJ. Methods and consequences of changes in use of episiotomy. BMJ 1994; 309:1255-8.

Robinson J, Norwitz E, Cohen A, Lieberman E. Predictors of episiotomy use at first spontaneous vaginal delivery. Obstet & Gynecol 2000; 96(2):214-8.

Wu L, Lie D, Malhotra R, Allen J, Tay J, Tan T, et al. Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery. Arch Gynecol Obstet 2013a; 288:1249-56.

Wu L, Lie D, Malhotra R, Allen J, Tay J, Tan T, et al. What factors influence midwives’ decision to perform or avoid episiotomies? A focus group study. Midwifery 2013b; 29:943-9.

Trochez R, Waterfield M, Freeman R. Hands on or hands off the perineum: a survey of care of the perineum in labor (HOOPS). International Urogynecology Journal 2011; 22: 1279-85

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Lohr K. Outcomes of routine episiotomy: a systematic review. J Am Med Assoc 2005; 293:2141-8.

Fullerton J, Severino R, Brogan K, Thompson J. The International Confederation of Midwives’ study of essential competencies of midwifery practice. Midwifery 2003; 19(3):174-90.




How to Cite

Piro, S. S., & Ahmed, H. M. (2016). Midwives’ perspectives regarding episiotomy practice in Kurdistan region/Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 20(1), 1233_1240. https://doi.org/10.15218/zjms.2016.0014



Original Articles