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Info Sheet: Episiotomy

Posted on June 18, 2013 at 8:40 AM
Episiotomy:  A surgical cut made at the opening of the vagina during childbirth

Anatomy of the perineum
Anatomy of the perineum
From WikiCommons
Types of Episiotomy
Types of Episiotomy
From WikiCommons
Definitions from WikiParents:
1st Degree – This is a small incision that goes through just the skin of the perineum
2nd Degree – This is the most common degree of episiotomy, it cuts through both the skin of the perineum as well as the underlying tissue
3rd Degree – Cuts through the skin of the perineum as well as the underlying tissue and the muscle that surrounds the anus
4th Degree – Through the skin of the perineum as well as the underlying tissue and the muscle that surrounds the anus and into the lining of the rectum
Midline - the incision is made starting at the vaginal opening, and continues in a straight line towards the anus
Medio-lateral - begins at the vaginal opening and angles off towards the buttocks at a 45 degree angle.


Why was it developed?  What was it supposed to treat?
Mayo Clinic: “An episiotomy was thought to help prevent more extensive vaginal tears during childbirth — and heal better than a natural tear. The procedure was also thought to keep the bladder from drooping and the rectum from protruding into the vagina after childbirth.”
Medicine.Net: “It can also decrease trauma to the vaginal tissues...Doctors who favor episiotomies argue that a surgical incision is easier to repair than a spontaneous irregular or extensive tear, and is likely to lead to a more favorable outcome with fewer complications.”

Has it been effective?
Mayo Clinic: “Research suggests that routine episiotomies don't prevent these problems after all.”
2005 study conclusion: "Routine episiotomy achieves no short‐term goals that it has been hypothesized to achieve. Indeed, routine use is harmful to the degree that it creates a surgical incision of greater extent than many women might have experienced had episiotomy not been performed."

History:
From social to surgical: historical perspectives on perineal care during labour and birth
“A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98-138 A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention--most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a re-emergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice.”
Copyright © 2010 Australian College of Midwives.

Pros - When an episiotomy might be medically necessary:
  • Baby is in an abnormal position and might need manipulation or forceps to aid in vaginal delivery
  • Baby needs to be delivered quickly due to fetal distress
  • Extensive vaginal tearing appears likely: easier to repair a single cut than multiple jagged edges

Cons of episiotomy:
  • Higher incidence of a third or fourth degree tear that extends into the external anal sphincter and the rectum
  • More blood loss
  • More pain and discomfort in the postpartum period
  • Painful intercourse
  • Incontinence
  • Additional surgeries to repair or reduce discomfort from initial episiotomy

Links to continue your research and draw your own conclusion about what is best for your family:
2005 Hartmann et al Study The Use of Episiotomy in Obstetrical Care: A Systematic Review: Summary
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010365/

Has the incidence of episiotomy decreased since the 2005 study:

From The Mayo Clinic:
Epsiotomy: When It’s Needed, When It’s Not

From Childbirth Connection
Preventing Pelvic Floor Dysfunction: Episiotomy

From Childbirth Connection
Preventing Pelvic Floor Dysfunction: Tips & Tools to avoid episiotomy

Science & Sensibility
What Is the Evidence for Perineal Massage During Pregnancy to Prevent Tearing?

Science & Sensibility
Tribute to Dr. Michael Klein with video about history of episiotomy and information about his studies

Summary of Dr. Klein’s Study

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer:  
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Categories: Episiotomy, Info Sheet, Information Sheet

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