Generality
The episiotomy is a rather common surgical procedure in obstetric practice, aimed at facilitating the passage of the fetus during vaginal birth.
Also called perineotomy, the episiotomy involves the incision of the perineum (the area between the vulva and the anus) in order to increase the distension of the vaginal orifice.
Because it is practiced
Alleged advantages
The episiotomy was introduced into clinical practice in the first half of the eighteenth century and has known up to recent times a remarkable popularity, with great propensity for its routine execution by doctors.
The rational of the intervention lies in the belief that this practice can reduce:
- in the mother, the risk of laceration of the perineum and the possible fecal and urinary incontinence due to childbirth;
- in the fetus, the risk of dystocia of the shoulders 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 wounds.
Disadvantages
The benefits classically attributed to episiotomy have long been accepted as truthful, although there was no 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 those cases in which the benefits of the intervention outweigh its disadvantages. Among the latter there would be:
- increase in postpartum hemorrhage (the episiotomy has an inhibitory effect on the secretion of oxytocin, a hormone that tends to increase uterine contractions, important for the arrest of hemorrhage resulting from the detachment of the placenta);
- local pain that can last weeks or months after childbirth, hindering the resumption of sexual relations and, in some cases, even interfering with breastfeeding;
- the wound can get complicated with infections; in the most serious cases it may even come to form rectovaginal fistulas;
- the laceration (and consequent weakening) of the pelvic floor muscles can create serious problems of incontinence.
For all these reasons, the episiotomy should be reserved only for particular cases, for example when the woman has a narrow birth canal or when the child that is about to be born is macrosomic, enters into suffering or presents herself with the testicles.
How to prevent the need to practice it
During pregnancy it is important that the woman acquires the awareness that the vagina and the perineum have the ability to lie 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 time required for the delivery, the birth in the water and the stimulation of the clitoris as a method of Relaxation during childbirth can be very useful for preventing vaginal and perineal lacerations.
How it is performed
The incision of the perineum can be made in three main ways: median (longitudinal incision), lateral (transverse incision) and mediolateral (oblique incision).
The choice of the type of incision is made by the surgeon also based on the characteristics of the patient, the fetus and the way in which it occurs. Generally speaking, the median incision tends to be preferred because it is more conservative and easy to heal.
The operation is carried out under local anesthesia, clearly unnecessary if the woman has already been subjected to epidural anesthesia.
Post-operative treatment
After the birth of the child, the wound produced by the episiotomy is closed with some stitches, always under local anesthesia (this intervention 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 gently dabbing with a clean, soft towel. If the doctor deems it appropriate, it is also possible to apply creams or anesthetic sprays to mitigate the pain.
