An episiotomy is a surgical incision in the perineum (the area of skin between the vagina and the anus). It is also a large controversy in childbirth today.
Episiotomies are measured in degrees -- the most common being a 2nd degree (midway between the vagina and the anus) and the least common being a 4th degree (Extending through the rectum, called the episiorectoprotomy). There are also different types of episiotomy. The midline is the most common in the USA (it extends directly towards the anus), and the mediolateral is a diagonal cut toward either side to prevent tearing into the rectum.
Dr. JM Thorp, in Episiotomy: Can its routine use be defended?, says, "There is little evidence to support routine use of episiotomy. This procedure may well increase the incidence of third- and fourth-degree lacerations. There are few data to support the premise that this procedure prevents pelvic relaxation."
The American College of Obstetricians and Gynecologists say that episiotomy "is not always necessary" and "should not be considered routine."
Episiotomies are said to provide the following benefits:
- Speed up the birth
- Prevent Tearing
- Protects against incontinence
- Protects against pelvic floor relaxation
- Heals easier than tears
The following have been reported as side effects of the episiotomy:
- Increased Pain
- Increase in 3rd and 4th degree vaginal lacerations (euphemistically called extensions)
- Longer healing times
- Increased discomfort when intercourse is resumed
Episiotomies are not always necessary, and there is much you can do to lessen your chances of having this surgical incision. Some preventative measures are:
- Good nutrition (Healthy skin stretches more easily)
- Kegels (exercise for your pelvic floor muscles)
- Prenatal discussion with your care provider about episiotomy
- Prenatal Perineal massage
- A slowed pushing stage (second stage)
- Warm compresses, perineal massage and support during delivery
As always, knowing your rights as a patient/client and being knowledgeable about your body and the proposed procedure will take you a long way. Good luck and good birth!
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Althabe F, Buekens P, Bergel E, Belizán JM, Campbell MK, Moss N, Hartwell T, Wright LL; Guidelines Trial Group. A behavioral intervention to improve obstetrical care. N Engl J Med. 2008 May 1;358(18):1929-40.
Mikolajczyk RT, Zhang J, Troendle J, Chan L. Risk factors for birth canal lacerations in primiparous women. Am J Perinatol. 2008 May;25(5):259-64.
Sze EH, Ciarleglio M, Hobbs G. Risk factors associated with anal sphincter tear difference among midwife, private obstetrician, and resident deliveries. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Mar 13.
Use of Episiotomy and Forceps During Childbirth Down, C-Section Rates Up. AHRQ News and Numbers, April 28, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/nn/nn042811.htm
Yildirim G, Beji NK. Effects of pushing techniques in birth on mother and fetus: a randomized study. Birth. 2008 Mar;35(1):25-30.