Generality
Episiotomy is a fairly common surgery in obstetric practice, aimed at facilitating the passage of the fetus during vaginal birth.
Also called perineotomy, episiotomy involves incision of the perineum (the area between the vulva and the anus) in order to increase the distension of the vaginal orifice.
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Why is practiced
Alleged benefits
Episiotomy was introduced into clinical practice in the first half of the eighteenth century and has enjoyed considerable popularity until recent times, with great propensity for its routine execution by doctors.
The rationale for the intervention lies in the belief that this practice can reduce:
- in the mother, the risk of tearing the perineum and possible fecal and urinary incontinence due to childbirth;
- in the fetus, the risk of shoulder dystocia and other complications, such as hypoxia in complicated labor.
In practice, the creation of such a wound would serve to prevent more serious and uncontrolled injuries.
Disadvantages
The benefits classically ascribed to episiotomy have long been accepted as true, despite the lack of concrete scientific evidence to support these hypotheses.
Only in recent years, statistical evaluations have led many doctors to discourage the routine practice of episiotomy, reserving it only for cases in which the benefits of the intervention outweigh its disadvantages. Among the latter there would be:
- increased post-partum bleeding (episiotomy has an inhibitory effect on the secretion of oxytocin, a hormone that tends to increase uterine contractions, important for stopping the bleeding resulting from placental abruption);
- local pain that can last weeks or months after childbirth, hindering the resumption of sexual intercourse and, in some cases, even interfering with breastfeeding;
- the wound can become complicated with infections; in the most serious cases, recto-vaginal fistulas can even form;
- the laceration (and consequent weakening) of the pelvic floor muscles can create serious incontinence problems.
For all these reasons, episiotomy should be reserved only for special cases, for example when the woman has a narrow birth canal or when the baby who is about to be born is macrosomal, goes into distress or presents breech with testicles.
How to prevent the need to practice it
During pregnancy it is important for women to become aware that the vagina and perineum have the ability to stretch adequately during childbirth, without the need for surgical intervention.
The preparation of the pelvic floor during pregnancy, the choice of an adequate position during labor, the right frequency and intensity of the thrusts, the respect of the times necessary for the completion of the birth, the water birth and the stimulation of the clitoris as a method of relaxation during childbirth, can be very useful in preventing vaginal and perineal lacerations.
How to do it
The perineum incision can be performed in three main ways: median (longitudinal incision), lateral (transverse incision) and mediolateral (oblique incision).
The choice of the type of incision is also made by the surgeon on the basis of the characteristics of the patient, the fetus and the way it presents itself. Generally speaking, the midline incision is preferred because it is more conservative and easy to heal.
The operation is performed under local anesthesia, clearly superfluous if the woman has already undergone epidural anesthesia.
Post-operative treatment
After the birth of the child, the wound produced by the episiotomy is closed with a few stitches, again under local anesthesia (this operation tends to be more painful than the incision itself).
In the following days it is necessary to pay particular attention to the disinfection of the wound, to be practiced several times a day and always after urination and defecation, according to the indications of the gynecologist with specific products. After washing, it is important to dry the wound with warm air or by gently blotting with a clean, soft towel. If your doctor deems it appropriate, you can also apply anesthetizing creams or sprays to relieve pain.
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