Episiotomy
From Freepedia
Image:Medio-lateral-episiotomy.gif
An episiotomy /ɛˌpiːziːˈɔːtʌmiː/ is a surgical incision through the perineum made to enlarge the vagina and assist delivering the baby. The incision can be midline or at an angle from the posterior end of the vulva, is performed under local anaesthetic and is sutured closed after delivery. It is one of the most common medical procedures performed on women.
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Uses
Physicians use episiotomies to lessen perineal trauma, minimize postpartum pelvic floor dysfunction by reducing anal sphincter muscle damage, reduce the loss of blood at delivery, and protect against neonatal trauma. In many cases though, episiotomies cause all of these problems.
Episiotomies may be indicated if:
- there is any sign of fetal distress while the baby is in the birth canal
- a delivery occurs too quickly for the vagina to stretch naturally
- the baby's head is too large for the opening
- the baby's shoulders are stuck
- it is a breech birth or forceps delivery
Controversy about common usage
In various countries, routine episiotomy has been accepted medical practice for many years. Various urban legends circulate 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 obstetricians and midwives in 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 postpartum period, 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 maneuver on 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 antenatal care, 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 midwife or obstetrician may 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
The birth position commonly used in Western hospitals, while convenient for hospital staff, works against gravity. The baby must be pushed up and over the perineum, and will tend to slam right into it. Birth will often go easier if the mother chooses a position that avoids this. Good positions include squatting, on all fours, and a very upright sitting or kneeling position with one leg up. These positions also provide the woman with a greater feeling of control and authority, which may be helpful when insisting on the right to refuse unnessesary medical procedures.
Perineal massage with 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.
Labor induction commonly leads to many other interventions including episiotomy, and thus should be avoided by mothers wishing to avoid this surgery. Birth is easier if the birth canal has naturally softened as it does prior to a natural birth.
It is wise to demand that surgical tools be moved outside of the room. Their use will be less likely if they are not within sight and within arm's reach.
References
- Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA 2005;293:2141-8. PMID 15870418.
- Signorello LB, Harlow BL, Chekos AK, Repke JT. Midline episiotomy and anal incontinence: retrospective cohort study. BMJ 2000;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 episiotomy
