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Episiotomies

Anne Cavicchi

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One of the most controversial procedures in delivery rooms today is the episiotomy. The surgical incision in the perineum (the area of skin between the vagina and the anus) is seen by some as necessary or routine and by others as not. They are performed in 80 - 90% of first births and 50% of subsequent births.

There are two basic types of episiotomies -- the median (also sometimes called midline) and the mediolateral. With the median, the cut extends directly towards the anus. With the mediolateral, a diagonal cut is made toward either side to prevent tearing into the rectum.

Episiotomies are also measured in degrees -- the most common being a 2nd degree which extends midway between the vagina and the anus and the least common being a 4th degree which extends through the rectum, called the episiorectoprotomy.

Episiotomies may provide the following benefits: Speeds up the birth Prevents tearing Protects against incontinence Easier & faster healing than tears

These all sound like reasonable reasons to have an episiotomy. However, in many of the cases, the opposite may actually true. Episiotomies can actually cause harm.

Side effects of the episiotomy include:

InfectionIncreased Pain Increase in 3rd and 4th degree vaginal lacerations Longer healing times Discomfort when intercourse is resumed

Episiotomies are not always necessary. Some preventative measures include:

Good nutrition (since healthy skin stretches more easily)Do your Kegels! Perineal massage A slowed and controlled pushing stageWarm compresses, perineal massage and support during delivery

Episiotomy should not be a routine part of labor and delivery according to Obstetrics & Gynecology. In addition, the American College of Obstetricians and Gynecologists (ACOG) does not recommend routine use of episiotomies.

Remember though, as with any medical procedure, there are times where it is a valid option. You may wish to discuss episiotomies in detail with your practitioner and prepare a birth plan to also let your wishes be known. But be prepared to be faced with the decision in the delivery room as well since this is not always a decision that can be firmly made before hand.

Episiotomies -- What You Should KnowPreparing for an Easy DeliveryBirth Plans How to Prepare Your Birth Plan


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