Will I need an Episiotomy

What is an Episiotomy?

Introduction

What is an Episiotomy? An episiotomy is a cut (surgical incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth. Although childbirth is a natural process it may require medical intervention to ensure the safety of both mother and child. This article considers the use of episiotomy in obstetrics, exploring its indications, controversies, and current medical use.

Indications

Traditionally, it was performed to help delivery, prevent severe tearing, and reduce maternal and foetal complications. Episiotomy was performed in cases of prolonged labour, foetal distress, or when instrumental delivery (e.g., forceps) was anticipated. Proponents argued that controlled incisions could minimize trauma to the perineum, However, over the years, its routine use has been questioned.

Episiotomy Controversies

Episiotomy gained popularity in the 20th century as a routine obstetric procedure aimed at preventing severe perineal tears Despite its historical prevalence, episiotomy has become a subject of controversy in contemporary obstetrics. Critics argue that routine episiotomy may lead to unnecessary trauma, increased risk of severe perineal lacerations, and long-term pelvic floor dysfunction. Studies have challenged its benefits, suggesting that selective or restrictive use may be preferable.

Indications for Episiotomy

While episiotomy was once routinely performed, contemporary obstetric practice emphasizes selective and judicious use based on specific indications. Indications for episiotomy may include:

  • Prolonged second stage of labour
  • Foetal distress necessitating quicker delivery
  • Instrumental deliveries, such as forceps or vacuum extraction
  • Prevention of severe perineal tearing in certain high-risk cases

Benefits of Episiotomy

Proponents of episiotomy argue that the procedure can offer several potential benefits, including:

  • Controlled, predictable incision compared to unpredictable tears
  • Prevention of severe perineal tears that may extend to the anal sphincter
  • Reduced risk of maternal pelvic floor damage and urinary incontinence
  • Facilitation of instrumental deliveries, potentially reducing maternal and neonatal trauma

Risks and Complications

Despite its perceived benefits, episiotomy is not without risks and potential complications, which include:

  • Increased risk of perineal pain and discomfort postpartum
  • Delayed wound healing and risk of infection.
  • Higher likelihood of blood loss compared to spontaneous tears.
  • Potential long-term complications such as dyspareunia (painful intercourse) and pelvic floor dysfunction

Contemporary Practices and Guidelines

 In recent decades, there has been a shift towards restrictive episiotomy use in many obstetric practices worldwide. Professional organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) have issued guidelines advocating for selective rather than routine use of episiotomy.

Can you have a normal delivery without an episiotomy?

Normally, if there are no obstetric complications or there are no special indications, the obstetricians or midwives in charge of the case will support mothers to plan to give birth, without episiotomy.

Should a Birth Plan include episiotomy?

Discussing episiotomy in a birth plan is entirely appropriate and recommended. A birth plan is a document that outlines a person’s preferences and wishes for labour and delivery, including their preferences regarding interventions, pain management, and postpartum care.

Conclusion: The use of episiotomy in obstetrics remains a topic of ongoing debate, with different views regarding its benefits, risks, and appropriate indications. While episiotomy was once a routine obstetric intervention, contemporary practice emphasizes selective use based on specific clinical indications, with an emphasis on minimizing unnecessary interventions and promoting maternal health and well-being.

References:

  1. Carroli, G., & Mignini, L. (2009). Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, (1).
  2. Lappen, J. R., & Gossett, D. R. (2007). Episiotomy: indications, technique, and risks. The Obstetrician & Gynaecologist, 9(2), 99-104.
  3. World Health Organization (WHO). (2018). WHO recommendations: Intrapartum care for a positive childbirth experience.
  4. American College of Obstetricians and Gynecologists (ACOG). (2018). ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstetrics & Gynecology, 132(3), e87–e102.
  5. Royal College of Obstetricians and Gynaecologists (RCOG). (2015). The Management of Third- and Fourth-Degree Perineal Tears (Green-top Guideline No. 29). BJOG: An International Journal of Obstetrics & Gynaecology, 122(Suppl. 1), 1–38.
  6. Jiang, H., Qian, X., Carroli, G., Garner, P., & XC. (2017). Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, (2), CD000081.
  7. Lund, N., Laine, K., & Gissler, M. (2017). Perinatal outcome of births planned by means of in vitro fertilization (IVF) compared with spontaneous conception. European Journal of Obstetrics & Gynecology and Reproductive Biology, 217, 116–120.
  8. Betrán, A. P., Temmerman, M., Kingdon, C., Mohiddin, A., Opiyo, N., Torloni, M. R., & Zhang, J. (2018). Interventions to reduce unnecessary caesarean sections in healthy women and babies. The Lancet, 392(10155), 1358–1368.

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