Episiotomy

An episiotomy [[International_Phonetic_Alphabet_for_English|]] is a surgical incision through the perineum made to enlarge the vagina and assist delivering the baby. The incision can be midline or at an angle from the posterior end of the vulva, is performed under local anaesthetic and is sutured closed after delivery. It is one of the most common medical procedures performed on women.

Overview

Physicians use episiotomies to lessen perineal trauma, minimize postpartum pelvic floor dysfunction by reducing anal sphincter muscle damage, reduce the loss of blood at delivery, and protect against neonatal trauma.

Episiotomies may be indicated if:

• there is any sign of fetal distress while the baby is in the birth canal
• a delivery occurs too quickly for the vagina to stretch naturally
• the baby's head is too large for the opening
• the baby's shoulders are stuck
• it is a breech birth or forceps delivery

Controversy about common usage

Episiotomies are rapidly losing popularity among obstetricians in the United States. "Data from a nationwide survey revealed that 31% of women having babies in U.S. hospitals received episiotomies in 1997, compared with 56% in 1979." Recent studies indicate that episiotomies should not be a routine procedure and may increase morbidity.

Having an episiotomy may increase perineal pain in the postpartum period, resulting in trouble defecating. A recent study showed "women who had episiotomies had a five times higher rate of uncontrolled bowel movements three months after giving birth compared with the group with no perineum injury."

Practical information

Expectant mothers should discuss their views on episiotomy with their carers during antenatal care or as early as possible in labour. In the final stages of delivery the midwife or obstetrician may not have time to discuss the benefits, risks and alternatives without endangering the mother or baby.

Perineal massage with Vitamin E oil or pure vegetable oil beginning around the 34th week is an unproven way to make the perineum more flexible and reduce the need for episiotomy.

Outside links

• Graphic photo of episiotomy.
• Medical diagram of episiotomy.

References

• --. Do I need to have an episiotomy?. WebMD Health visited 12/27/2004.

• L.A. McKeown. Common Procedure During Delivery Linked to Lasting Rectal Injuries. WebMD Medical News visited 12/27/2004.

• Salynn Boyles. Episiotomy Rates Drop Sharply. WebMD Medical News visited 12/27/2004.