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Episiotomy
An episiotomy is a surgical incision made to enlarge the vaginal
opening during childbirth to assist delivery of the baby. This
incision can be midline or at an angle from the posterior end of the
vulva. It should be performed under local anaesthetic and should, of
course, be sutured closed after delivery.
Proponents of episiotomies say it helps to lessen perineal trauma,
minimize postpartum pelvic floor dysfunction, reduce blood loss at
delivery, and protect against neonatal trauma.
Current medical thinking is that routine episiotomies are probably
unnecessary and only bring about increased morbidity. There are
studies showing that episiotomies did not, in fact, reduce the
incidence of serious perineal lacerations but increased them.
Having an episiotomy may increase perineal pain in the postpartum
period. This can result in trouble defecating, much to the new
mother's despair.
It has been argued that episiotomies should not be a routine
procedure. It appears that it will end up being practiced less and
less often as time goes on, much like circumcision. Until then, the
social entrenchment of belief in this procedure will ensure that it
continues being performed far more often than it should.
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Episiotomies may be indicated if there is any sign of fetal distress
while the baby is in the birth canal or there are clinical indications
to deliver the baby quickly.
Perineal massage in the period prior to childbirth is intended to
reduce the need for episiotomy, by making the perineum more flexible.
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