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Approche psychodynamique de l’impact de l’épisiotomie : étude longitudinale chez des femmes primipares

Abstract : Episiotomy is an enlargement of the vaginal orifice made by a surgical incision of the perineum during the delivery and especially during the last stage of expulsion. Mostly studied in a somatic angle, this surgical practice has been very little studied from a psychological point of view. Moreover, there is no psychodynamic study on episiotomy. The aim of this research is to evaluate the psychical impact of episiotomy with three different types of evaluations: the effects of episiotomy, the risk and protective factors associated with the difficult experience of episiotomy and finally the subjective and individual experiences. We conducted a longitudinal study which was performed on 43 women. It compared the effect of episiotomy with other modes of delivery (caesarean section, vaginal approach with intact or pseudo-intact perineum and perineal injuries). It relied on a prenatal appointment (1 month before delivery), an assessment 2 days and 2 months after the delivery and finally 3 postnatal meetings (3 months, 9 months, 1 year). Each one of them was based on interviews (semi-directive and free), questionnaires (SF36, QIC, EPDS, CPQ, WOMBLSQ4, Traumaq) and the use of the Rorschach test. The main results show that 2 months after delivery, episiotomy implies a lower satisfaction related to childbirth. Perineal incision has stronger correlation with the presence of pain, dyspareunia and depression 3 months after childbirth. In addition, with the perineal injuries group, episiotomy is considered as one of the most difficult ways to give birth. Our study also showed that a low quality of mentalization protect women from a hard experience related to episiotomy. Finally, the qualitative analysis showed that episiotomy is specifically linked to sexual dysfunctions and somatopsychic anxieties. To finish, we have shown that personal subjective experiences influence the perception of episiotomy (particularly through the transferential dynamics projected on the medical team and the revival of psychical traumas). All these results are also commented in a theoretical and clinical point of view which aims to improve the well-being of women in the delivery room and afterwards
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Submitted on : Monday, June 22, 2020 - 4:18:48 PM
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Christophe Clesse. Approche psychodynamique de l’impact de l’épisiotomie : étude longitudinale chez des femmes primipares. Psychologie. Université de Lorraine, 2018. Français. ⟨NNT : 2018LORR0236⟩. ⟨tel-02104112⟩



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