Episiotomy
Definition
Episiotomy is a procedure where the skin between the vagina and the anus is cut. (This area is called the 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 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
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 babys heart rate.
Risks
Episiotomies were once routinely performed to prevent vaginal tears during delivery. Today, routine episiotomies are not recommended, and the The American College of Obstetrician-Gynecologists recommends the procedure only in some deliveries. A review of episiotomies, published in the Journal of the American Medical Association, found that the procedure offers no benefit, and stated there was no evidence to suggest it improves a woman's sexual function. It also found that women who have an episiotomy have more intercourse-related pain after pregnancy and take longer to resume having sex after childbirth.
Additional risks include:
- Bleeding
- Bruising
- Incontinence
- Infection
- Swelling
Outlook (Prognosis)
An episiotomy usually heals without problems and may be easier to repair than multiple tears. It is also thought to help prevent vaginal stretching and to tighten the vagina after delivery. However, some women have prolonged pain with intercourse after the procedure.
Recovery
Normal activities can be resumed shortly after birth. The stitchesare absorbed by the body and do not need to be removed.Pain and discomfort can be relieved with warm baths and medications.
References
Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA. 2005 May 4;293(17):2141-8.
American College of Obstetricians-Gynecologists. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Practice Bulletin. April 2006: Number 71.
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, 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.
