The objective of this study was to evaluate the differences in the childbirth experience among women with different degrees of perineal injury, as well as the difference in the childbirth experience based on the presence or absence of perineal injury, including a group with the presence of selective episiotomy.

The cross-sectional study, clinical, not surgical, took place at a teaching maternity facility. The study was performed with the ethical committee approval. The sample consisted of 125 postpartum women who had vaginal deliveries. Women under 18 years of age or those who did not have adequate fluency in the language of the questionnaire were not included. The sample was divided into 5 groups: intact perineum group (PI); grade 1 laceration group (L1); grade 2 laceration group (L2); grade 3 and 4 lacerations group (L3-4); and episiotomy group (E). After agreeing to the informed consent terms, the participants responded to the Birth Experience Questionnaire (CEQ-B) which was developed by DENCKER et al. This instrument includes statements divided into four domains: self-capacity, professional support, perceived safety sensation, and women's participation in labor and delivery. There are 22 statements, 19 of which are multiple-choice statements containing 4 possible alternatives (strongly agree, mostly agree, mostly disagree, strongly disagree) and 3 of the statements used the Visual Analog Scale (VAS). A predefined score is assigned based on the responses, and a final score is calculated, quantifying the birth experience, with higher scores associated with a better experience. Additionally, domain scores can be calculated to assess the experience regarding its different components separately. The post hoc sample size analysis, with an effect size of 0.47, with a sample of 125 participants, and an alpha of 5% for one-way ANOVA with 5 groups, we obtained more than 80% of power.

For comparison of parametric variables between groups, a one-way ANOVA was conducted using Jamovi software version 2.3.13.0. The variables analyzed were age, total questionnaire score, as well as the score for each domain (Self-Capacity, Professional Support, Perceived Safety, and Participation). Regarding the age variable, there was no statistically significant difference between groups (p=0.47), indicating that this factor does not seem to have influenced the analysis. The participants' mean age was 26.6, with a maximum of 47 years and a standard deviation of 5.8.
The ANOVA results showed a significant difference between groups for the total questionnaire score. To determine between which groups the difference existed, Tukey's post hoc test was conducted, revealing a significant difference between groups L2 (grade 2 laceration) and L3-4 (grade 3 and 4 lacerations) for the total birth experience score, with ptukey=0.02, Cohen’s d=0.93, CI [0.3-1.5], where group L2 had a mean score of 68.2 and group L3-4 had a mean score of 58.1 points. 
There was also a trend towards a difference between groups L1 and L3-4, with ptukey=0.06, Cohen’s d=0.78, CI [0.19-1.36], where group L-1 had a mean score of 66.6 and group L-3-4 had a mean score of 58.1 points. Although the p-value was not less than 0.05, the confidence interval does not contain zero, indicating a significant difference.
The ANOVA results also showed a statistically significant difference between groups for the Professional Support domain (p=0.02). Tukey's post hoc test revealed a difference between groups L-1 (grade 1 laceration) and L3-4 with ptukey=0.03, Cohen’s d=0.88, CI [0.29-1.46], where group L-1 had a mean score of 18.7 and group L-3-4 had a mean score of 15.8 points in this domain. There was also a significant difference between groups L-2 and L3-4 with ptukey=0.02, Cohen’s d=0.95, CI [0.34-1.56], where group L-2 had a mean score of 19 and group L-3-4 had a mean score of 15.8 points in this domain.

The "grade 3 and 4 perineal laceration" factor seems to have influenced a lower score in the Professional Support domain compared to lower grade lacerations, grade 1 and 2. Quantitatively assessing this aspect, group L3-4 seemed to feel less cared for by the assisting team compared to groups L1 and L2, which gave a better evaluation in this domain.
The "grade 3 and 4 perineal laceration" factor seems to have been decisive for a worse overall birth experience, measured by the total score, compared to lower grade lacerations, grades 1 and 2. Our hypothesis is that this could be a consequence of the significant disparity in the evaluation of professional support between these groups. 
There was no significant difference in birth experience between the episiotomy intervention group (group E) compared to the other groups. This could indicate that the intervention was interpreted by these patients as a form of care during labor.

Although the significant difference in the birth experience between groups L3-4 and group L-2 seems to have been influenced by the difference in the domain of professional support, it is challenging to assess whether this feeling of less care corresponded to reality, being a contributing factor to the laceration event, or if, because they experienced a laceration, the patients felt they could have been better supported during labor. Additionally, patients with extensive lacerations often undergo extensive reparative procedures postpartum, including surgical intervention, which may indirectly influence their birth experience. Postpartum is a moment of first skin-to-skin contact with the newborn, the first breastfeeding, among many other experiences that, although part of the postpartum period, contribute to the subjective experience and indirectly indicate the presence of a peaceful birth. The fact that patients with grade 3 and 4 lacerations possibly narrowed this experience due to the need to be absent for surgical procedure may have influenced the poorer evaluation of the birth experience.
It also needs to be highlighted the importance that proceeding with episiotomy during labor did not result in a worse experience compared to the other groups.