Episiotomy

Answer 1

Definition

Episiotomy is a procedure in which the skin between the vagina and anus is cut. (This area is called the perineum.) Episiotomy is done occasionally to enlarge the vaginal opening so that a baby can be more easily delivered.

Description

Just before the baby is born, the obstetrician numbs the vaginal area opening and makes one of two cuts:

• A mediolateral cut is angled down away from the vagina and into the muscle.
• A midline cut is made straight down between the vagina and anus.

The cut makes the opening to the vagina bigger. The cut is stitched closed after the baby and placenta have been delivered.

Why the Procedure Is Performed

Episiotomies were once routinely performed to prevent vaginal tears during delivery. Today, routine episiotomies are not recommended.

However, episiotomies may still be performed when there is a complicated delivery. An episiotomy may be needed if the baby's head or shoulders are too big for the mother's vaginal opening, or the baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.

It may also be needed to speed the delivery process if there is concern about the baby's heart rate.

Risks

Many studies have found that the procedure offers no benefit in routine deliveries, and there is no evidence to suggest that it improves a woman's sexual function. It has also been found that women who have an episiotomy have more intercourse-related pain after pregnancy and take longer to resume having sex after childbirth.

If an episiotomy cut is made, there is more of a chance that it will become a larger tear or even extend into the muscles around the rectum. This can lead to later problems with controlling gas and sometimes stool. When no episiotomy is made and a woman is just allowed to tear, these problems are less likely to happen.

Additional risks include:

• Bleeding
• Bruising
• Incontinence
• Infection
• Swelling

After the Procedure

An episiotomy usually heals without problems and may be easier to repair than multiple tears.

Outlook (Prognosis)

You can resume normal activities shortly after the birth. The stitches are absorbed by the body and do not need to be removed. You can relieve pain and discomfort with medication and ice in the first 24 hours, followed by warm baths.

References

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA. 2005;293(17):2141-2148.

American College of Obstetricians-Gynecologists. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Practice Bulletin. 2006;71.

Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews. 2009;1:CD000081.

Frankman EA, Wang L, Bunker CH, Lowder JL. Episiotomy in the United States: has anything changed? Am J Obstet Gynecol. 2009;200:573.e1-573.e7.

Answer 2

Definition

Episiotomy is a procedure sometimes done during childbirth to make a woman's vaginal opening bigger. This make it easier to deliver the baby.

Description

The skin between the vagina and anus is cut. This area is called the perineum.

Just before the baby is born, the obstetrician numbs the vaginal area opening and makes one of two cuts:

• A mediolateral cut is angled down away from the vagina and into the muscle.
• A midline cut is made straight down between the vagina and anus.

The cut makes the opening to the vagina bigger. The cut is stitched closed after the baby and placenta have been delivered.

Why the Procedure Is Performed

Episiotomies were once routinely performed to prevent vaginal tears during delivery. Today, routine episiotomies are not recommended.

However, episiotomies may still be done if:

• The baby's head or shoulders are too big for the mother's vaginal opening
• The baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery

It may also be needed to speed the delivery process if there is concern about the baby's heart rate.

Risks

Many studies suggest this procedure has no benefit during routine childbirth.

Women who have an episiotomy have more intercourse-related pain after pregnancy, and wait longer before having sex after childbirth.

There is a chance the episiotomy can lead to a larger tear, or it may tear the muscles around the rectum. This can lead to later problems with controlling gas and sometimes stool. These problems are less likely if you do not have an episiotomy, and the skin tears naturally during childbirth.

Additional risks of an episiotomy include:

• Bleeding
• Bruising
• Incontinence
• Infection
• Swelling

After the Procedure

An episiotomy usually heals without problems and may be easier to repair than multiple tears.

Outlook (Prognosis)

You can return to normal activities shortly after the birth.

The stitches are absorbed by the body and do not need to be removed.

Pain medication and ice can help relieve discomfort for the first day. After that, warm baths are helpful.

References

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA. 2005;293(17):2141-2148.

American College of Obstetricians-Gynecologists. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Practice Bulletin. 2006;71.

Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews. 2009;1:CD000081.

Cunningham FG, Leveno KJ, Bloom SL, et al. Normal labor and delivery. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 17.

Reviewed By

Review Date: 09/12/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.