Episiotomy

Image:Medio-lateral-episiotomy.gif

An episiotomy /ɛˌpiːziːˈɔːtʌmiː/is a surgicalincision through the perineummade to enlarge the vaginaand assist childbirth. The incision can be midline or at an angle from the posterior end of the vulva, is performed under local anaestheticand is suturedclosed after delivery. It is one of the most common medical procedures performed on women.

Uses

Physicians use episiotomies to lessen perinealtrauma, minimize postpartum pelvic floor dysfunctionby reducing anal sphincter muscle damage, reduce the loss of bloodat delivery, and protect against neonataltrauma. In many cases though, episiotomies cause all of these problems.

Episiotomies may be indicated if:

• there is any sign of fetal distresswhile the baby is in the birth canal
• a delivery occurs too quickly for the vaginato stretch naturally
• the baby's head is too large for the opening
• the baby's shoulders are stuck
• it is a breech birthor forceps delivery

Controversy about common usage

In various countries, routine episiotomy has been accepted medical practice for many years. Various urban legendscirculate on the fact that after very rapid natural births, young doctors would still make episiotomies so as not to displease their professors.

Since about the 1960s, routine episiotomies are rapidly losing popularity among obstetriciansand midwivesin Europe and the United States. A nationwide US population study by Weber and Meyn (2002) suggested that 31% of women having babies in U.S. hospitals received episiotomies in 1997, compared with 56% in 1979.

Recent studies indicate that routine episiotomies should not be performed, as they may increase morbidity. Hartmann et al (2005), reviewing the literature, indicate that this procedure is not helpful for routine patients, though there are certain instances, such as a narrow birth canal and other problems as described above.

Having an episiotomy may increase perineal pain in the postpartumperiod, resulting in trouble defecating(particularly in midline episiotomies, as demonstrated by Signorello et al 2000). In addition it may complicate sexual intercourse.

An intact perineum serves to perform a Heimlich maneuveron a baby born in the normal head-first orientation. This expels fluid from the baby's lungs.

Informed consent

Expectant mothers frequently make "birth plans" during their antenatalcare, and are generally encouraged to discuss their views on episiotomy with their carers, or as early as possible in labour. In the final stages of delivery the midwifeor obstetricianmay not have time to discuss the benefits, risks and alternatives without endangering the mother or baby. It is very common for birth plans to be completely ignored though. Following a birth plan may mean that a doctor's shift will be extended or that some other doctor is there for the delivery.

Avoidance

Perineal massagewith 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.

References

• Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA2005;293:2141-8. PMID 15870418.
• Signorello LB, Harlow BL, Chekos AK, Repke JT. Midline episiotomy and anal incontinence: retrospective cohort study. BMJ2000;320:86-90. PMID 10625261.
• Weber AM, Meyn L. Episiotomy use in the United States, 1979-1997. Obstet Gynecol 2002;100:1177-82. PMID 12468160.

External links

• WebMD Health– Do I need to have an episiotomy?
• NotJustSkin.org– Avoiding Vaginal Tears and Episiotomies
• Moondragon.org– Graphic photo of episiotomy
• ProHighway.com– Medical diagram of episiotomyde:Dammschnitt

fr:Épisiotomie id:Episiotomy

This article is licensed under the GNU Free Documentation License.
It uses material from the Wikipedia article Episiotomy.