Episiotomy
An episiotomy is a surgical procedure performed during childbirth to enlarge the vaginal opening, facilitating the delivery of a baby. It is not a routine intervention and is typically indicated in specific circumstances, such as when the baby is large, during rapid deliveries, or if the baby is in a breech position. The procedure involves making a controlled incision in the perineum, the area between the vagina and the anus, often with the aid of local anesthesia to minimize discomfort.
While episiotomies can prevent severe tearing of the vaginal tissues and anal sphincter, their routine use has diminished in recent years. Current practices emphasize the importance of only performing episiotomies when absolutely necessary, particularly to avoid complications for both the mother and child. After the procedure, healing usually occurs quickly, although some discomfort may persist for a short period. The trend toward minimizing episiotomies reflects a broader understanding of childbirth practices and a focus on maternal satisfaction and well-being. Techniques like perineal massage are increasingly encouraged to help reduce the need for surgical intervention during delivery.
Subject Terms
Episiotomy
Anatomy or system affected: Anus, genitals, reproductive system
Definition: A surgical cut made in the pelvic floor to enlarge the vagina for the facilitation of childbirth
Indications and Procedures
An episiotomy is performed to enlarge the vaginal opening and ease the delivery of a baby during childbirth. While not a routine procedure, some circumstances that indicate the need for an episiotomy include macrosomia (large fetal size), rapid delivery, breech delivery, and presentation of the baby with face to the front of the birth canal, all of which prevent the perineum (the area between the vagina and the anus) from stretching rapidly enough to prevent tearing. Scarring from vaginal surgeries also limits the ability of the vagina to expand.
During the procedure, a local anesthetic is injected into the perineum. The provider uses straight-bladed blunt scissors to snip the tissue between the vagina and anus diagonally, avoiding the anal sphincter muscle and preventing tearing into the anal sphincter. After delivery, the incision and any minor tears in the birth canal are carefully stitched together. Delivery by a nurse midwife as opposed to a private obstetrician is far less likely to result in an episiotomy, as nurse midwives do not routinely do episiotomies. Furthermore, with a nurse midwife, techniques such as vaginal-perinealmassage with warm oil are employed to help stretch the perineum and avoid the need for episiotomy.
Uses and Complications
The birth canal has very limited space to accommodate an infant, and situations such as feetfirst or face-forward presentation can lead to compression of the umbilical cord and interruption of the oxygen supply to the baby, or even to potential crushing of the infant. An episiotomy can facilitate a rapid delivery in these circumstances, thereby preventing serious injury to the infant. Failure of the perineum to stretch sufficiently to accommodate the child can result in severe, irregular tears of the vagina and even of the anal sphincter muscles. Ragged tears are difficult to repair surgically and much more prone to infection. Tearing of the anal sphincter could lead to permanent incontinence. The easily repaired incisions of episiotomy eliminate these potential difficulties.
Healing of the incisions is rapid and straightforward, but the area may itch and be somewhat painful for a few weeks. Painkilling drugs may be prescribed, and ice packs can be used to alleviate pain. Women who do not desire episiotomies and have controlled, problem-free deliveries may try to stretch the perineum gradually by massaging it with warm oil during the delivery. While episiotomies were considered a routine part of delivery in the past, they are now done less commonly, only as necessitated for conditions like those indicated above. Additionally, maternal satisfaction is increasing as episiotomies are being done more when they are necessary and to a lesser extent when they are avoidable.
In the 2020s, the prevailing opinion was that routine episiotomies were no longer recommended and should only be done if needed or in the case of emergencies. Examples are if the baby is stuck behind the mother’s pelvic bone or if, during delivery, an unusual heart rate is detected from the baby. The rationale that an incision may help prevent a larger tear is no longer deemed as a cause to administer a routine episiotomy. Current research has shown that episiotomies are not effective in preventing injuries and may in fact, contribute to the issue of torn tissues.
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