Episiotomy

An episiotomy is a surgical intervention performed during the second stage of labor and delivery, where an incision is made in the perineum -- the area between the vagina and anus -- to enlarge the vaginal opening for the delivery of the baby. The procedure is designed to prevent severe perineal tears that can occur during childbirth.

Blausen 0355 Episiotomy

Procedure

Medio-lateral-episiotomy

An episiotomy is typically performed as the baby's head is stretching the vaginal opening, just before delivery. After administering local anesthesia to numb the area, the doctor makes a small incision in the perineum. There are two main types of episiotomy:

• Midline episiotomy: The incision is made vertically from the vaginal opening straight towards the anus.
• Mediolateral episiotomy: The incision is made at an angle from the vaginal opening. This type is less likely to extend to the anus but can result in more pain during the recovery period and possible complications for sexual function.

Indications

The routine use of episiotomy during childbirth has been widely debated in the medical community. However, it may be performed in the following circumstances:

• When extensive vaginal tearing appears likely
• During a prolonged delivery that puts stress on the baby
• When forceps or a vacuum device is used for delivery
• When there is a medical need to speed up delivery

Risks and Complications

Despite its intended benefits, an episiotomy can lead to several complications:

• Increased blood loss
• More extensive perineal pain during recovery
• Risk of infection
• Possible complications with future vaginal deliveries
• Difficulties with sexual intercourse post-delivery

Recovery and Aftercare

The incision site is usually stitched up after the delivery of the baby and placenta. Pain management, hygiene of the wound area, and monitoring for signs of infection are crucial components of aftercare. Pelvic floor exercises may aid in the recovery process.

Current Practice and Recommendations

The routine use of episiotomy has been discouraged in recent years by several health organizations, including the World Health Organization (WHO) and the American College of Obstetricians and Gynecologists (ACOG). They recommend that the procedure should only be performed when it's absolutely necessary, considering the potential risks and complications. Evidence has suggested that restrictive use of episiotomy can lead to less postpartum pain and fewer complications than when the procedure is done routinely.

See Also

• Childbirth
• Perineal tear
• Postpartum period

References

Episiotomy Resources
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