Episiotomy

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An episiotomy is a surgical incision made to enlarge the vaginal opening during childbirth to assist delivery of the baby. This incision can be midline or at an angle from the posterior end of the vulva. It should be performed under local anaesthetic and should, of course, be sutured closed after delivery.

Proponents of episiotomies say the procedure helps to lessen perineal trauma, minimize postpartum pelvic floor dysfunction, reduce the loss of blood at delivery, and protect against neonatal trauma.

Current medical thinking is that routine episiotomies are probably unnecessary and only bring about increased morbidity. There are studies showing that episiotomies did not, in fact, reduce the incidence of serious perineal lacerations, but increased them.

Having an episiotomy may increase perineal pain in the postpartum period. This can result in trouble defecating, much to the new mother's despair.

It has been argued that episiotomies should not be a routine procedure. It appears that it will end up being practiced less and less often as time goes on, much like circumcision. Until then, the social entrenchment of belief in this procedure will ensure that it continues being performed far more often than it should.

Episiotomies may be indicated if there is any sign of fetal distress while the baby is in the birth canal or there are clinical indications to deliver the baby quickly.

Perineal massage in the period prior to childbirth is intended to reduce the need for episiotomy, by making the perineum more flexible; however the effectiveness of this technique is not proven.

As with all aspects of care it is best for expectant mothers to 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.

de:Dammschnitt