Definition

Episiotomy is the procedure of making a surgical incision through the perineum to enlarge the size of the vagina to assist childbirth. Perineum is the surface region, both in males and females, between the public symphysis (cartilaginous joint above the penis in males and above the vulva in females) and the coccyx (tailbone or the final column of the vertebrae). The incision or the cut can be midline or at an angle to tend of the vulva. This procedure is performed under the influence of local anesthetic and the cut is sutured i.e. surgically stitched, after delivery.

Controversies

The use of episiotomy was a common till the sixth decade of the 20th century, after which it has steadily declined. Many doctors and surgeons believed that episiotomies reduced the possibility of occurrence of many disorders like perineal trauma, postpartum pelvic floor dysfunction and excessive blood loss during delivery. However recent research has shown that it is episiotomy that causes these disorders. In addition to this, episiotomies also cause certain other disorders. It has been scientifically proved that episiotomies may increase morbidity i.e. the state of being diseased. Episiotomy can also increase the perineal pain in the postpartum period (the period of up to six weeks that follows immediately after birth), which results in trouble during defecating and makes sexual intercourses more painful. Therefore this procedure is used only if there are complications during the process of child birth, and is not used on a routine basis.

Applications and Prevention

Recent research has also shown that the natural tearing process that occurs during child birth, when episiotomy is not used, is less painful and the tears heal more quickly than the incision made during episiotomy. In spite of this episiotomy is used if there is a sign of fetal distress (the fetus being unwell or fatigued) while the baby is in the birth canal or if the delivery occurs too quickly for the vagina to expand in a natural manner. This procedure is also used if the baby’s head is too large for the opening, if the baby’s shoulders are struck or if it is a case of breech birth or forceps delivery i.e. if the baby is delivered in a buttocks first position as opposed to the normal heads first position.

Perineal massage, starting from around the 34th week, can reduce perineal damage by 6%. Controlled delivery of the head that allows slow and gradual stretching of the perineal tissue can also help in reducing the damage to the perineum. Devices like the “Epi - no” are used to stretch the perineal tissue gradually to train the tissue in preparation for birth, and is shown to reduce perineal damage by 50% at first births.