The Effect of Video-assisted Episiotomy Repair Training on Anxiety and Self-efficacy Levels in Midwifery Students: a Randomized Controlled Study

Episiotomy is one of the most commonly performed surgical interventions in normal vaginal birth. Episiotomy, also known as perineotomy, can be defined as an incision made in the perineum to ensure easy delivery of the fetus, shorten the active phase of labor, prevent lacerations, and protect the perineal tissue and anal sphincter. This procedure is a surgical intervention applied to the bulbo-cavernos muscle located in the perineum in the second phase of labor. It can be said that episiotomy has become widespread as a result of medicalization in birth, as in all areas of health. In particular, moving births from homes to hospital environments can be cited as one of the leading reasons for the increase in episiotomy rates. Routine episiotomy may cause pelvic organ prolapse and damage the muscles in the anal sphincters and perineal structure. In addition, studies on the subject have shown that episiotomy may be associated with problems such as postpartum pain, dyspareunia and incontinence. It is also known that the rate of perineal trauma is high in countries where episiotomy is frequently performed. For this reason, episiotomy, which is basically done to prevent uncontrolled damage that may occur in the perineal area, is not routinely preferred today. The recommendation of the American College of Obstetricians and Gynecologists (ACOG) regarding episiotomy is as follows: Episiotomy may be preferred in cases of risk arising from the mother or the baby, such as protecting against perineal tears that may occur in the mother during vaginal birth, facilitating or accelerating birth, but its use should be limited in cases where it is not necessary.

Self-efficacy is defined as the individual's beliefs about his ability to perform significantly in events that will affect his life. Self-efficacy perception determines how individuals feel, think, motivate themselves and behave. It is known that motivation increases as the level of self-efficacy increases). It has also been reported that individuals with high self-efficacy have a higher potential to cope with problems, experience less stress and anxiety, and make more effort to achieve their desired results. It is estimated that people with low self-efficacy often experience stress, anxiety and depression, and their academic and social success decreases. As a matter of fact, some studies have found that the academic performance of university students increases in parallel with their self-efficacy score averages.

The goal of midwifery undergraduate education is; To provide students with basic professional knowledge, skills and attitudes in cognitive, affective and psychomotor dimensions. Various practices are used to provide students with midwifery skills. Case studies, maintenance processes, laboratory applications, field studies, simulation application and video monitoring are some of these applications. Each of these approaches, which are especially preferred in applied courses, has an important place in increasing students' self-efficacy and reducing their anxiety. Episiotomy is one of the obstetric interventions that negatively affects the self-efficacy of midwifery students and causes anxiety. Midwives are responsible for performing and caring for episiotomy. In many countries, episiotomy repair training is given to midwifery students using sponges or models. However, today the use of calf tongue, which is very similar to perineal tissue, has become widespread. There are a limited number of studies in the literature using calf tongue simulation. These studies suggested that the practice improved the skills of midwifery students. No study has been found in the literature using video-assisted episiotomy repair training.