Episiotomies, a procedure in which a small incision is made in the perineum during childbirth, were once routine but are now considered unnecessary and potentially harmful. The procedure can increase the risk of deep lacerations and cause complications such as pain, infection, and incontinence. Women who wish to avoid an episiotomy should discuss their preferences with their medical team and consider measures such as perineal massage. However, in some cases, the procedure may be deemed medically necessary for the health of the mother or baby.
An episiotomy is a medical procedure in which a small incision is made in the perineum, which is the area between the anus and the vagina, during childbirth. The purpose of an episiotomy is to widen the vaginal opening to make it easier for a woman to give birth. At one time, the procedure was routine and very common worldwide, but further research has suggested that this medical intervention is unnecessary and may in fact be harmful to the mother.
The rationale behind an episiotomy is that it’s better to create a controlled incision with scissors than to allow for tearing during delivery. By deliberately making an incision, a doctor can control the depth and angle, making it easier to repair. In a mediolateral incision, the doctor cuts at an angle, while a midline incision runs along the perineum in a direct line from the vagina toward the anus. However, episiotomies actually appear to increase the risk of a deep laceration, because the incision essentially starts a small laceration that can expand during delivery.
There are also some serious complications associated with this procedure. After delivery, the site is usually painful and very tender, and it is difficult to urinate or defecate while keeping the wound clean. Episiotomies can also contribute to painful sex and the development of infections, and have caused incontinence in some cases. All of these risks have made many women extremely wary of an episiotomy.
If a child seems too big, the perineum isn’t fully stretching, or the tear has already begun, a doctor may recommend the procedure. Episiotomies are generally not done without the consent of the mother or someone who speaks for her, such as a partner or midwife. After delivery, the tear is stitched up and cleaned, and the woman is given care instructions that include gentle washing with mild soap, squatting to urinate, and bed rest to prevent further tearing.
Women who are strongly against having an episiotomy should make sure their medical teams are aware of this. There are also some measures that can be taken to avoid tearing, including perineal massage, in which the perineum is gently massaged and stretched for several weeks before delivery so that it expands more easily when the baby comes out. However, women should be aware that the best birth plan can go awry and that a doctor may deem an undesirable action medically necessary for the health of the baby or mother.
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