Episiotomy Necessity in Deliveries
Discover how episiotomy can improve outcomes for both mother and baby during labour but why it is no longer a prevalent practise.
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Last updated on 3rd Jul, 2025
During labour, an episiotomy is an incision made in the perineum, which is the tissue between the opening of the uterus and the anus. This procedure is intended to enlarge the uterus to facilitate a seamless childbirth. Historically, episiotomy was a standard practice of vaginal delivery. It was believed that it protected the pelvic muscles and joint tissues and lowered the risk of severe natural tears. However, modern studies disregard that claim.
Indications for Episiotomy
A closer look at when an episiotomy might be suggested during labour.
Foetal Distress: If the baby shows signs of concern, like an irregular heart rate pattern, an episiotomy may be needed to make sure the baby is safe and delivered right away.
Instrumental Delivery: If instruments like forceps or vacuum extraction are needed, an episiotomy creates more room for a safer delivery.
Prevention of Severe Perineal Tears: It is possible to avoid a big, uncontrollable tear with an episiotomy, especially if the perineum is under a lot of stress during birth.
Shoulder Dystocia: Shoulder dystocia is when the baby's shoulder gets stuck behind the pelvic bone. An episiotomy may be needed to make the birth quick and safe.
Current Trends in Episiotomy Practices
To understand how the methods and ideas used for episiotomies have changed in modern childbirth, one needs to follow its current trends. Routine episiotomies have become much less common because studies have shown that they don't save the mother from serious tears or future issues to the pelvic floor. The healthcare provider's training, the conditions of the mother and baby, and the patient's wishes all play a role in the choice to do an episiotomy.
These days, selective episiotomies are more common as evidence-based practices say that doctors shouldn't do too many needless procedures like episiotomies.
At the same time, rates of episiotomies change a lot from one area to the next because of differences in healthcare laws and cultural customs related to giving birth.
Benefits of Episiotomy
Here are some possible benefits of an episiotomy when used in certain childbirth situations
Delivery Time Reduction
In certain emergencies, an episiotomy can shorten the delivery time by creating a controlled incision. This can prevent complications like foetal distress, which benefits both the baby's and the mother’s health during delivery.
Avoiding Severe Perineal Damage
An episiotomy, when performed with care, can reduce the risk of severe perineal tears that may occur naturally during childbirth. This controlled incision aims to prevent more extensive damage, reduce pain, and aid faster recovery.
Facilitating Complex Deliveries
In cases of difficult deliveries, such as a breech birth or when the baby is unusually large, an episiotomy can provide the necessary space to assist the baby’s exit. This intervention can help prevent birth injuries to the mother and the child.
Instrumental Delivery Support
During an instrumental delivery, tools like forceps or vacuums become necessary to assist in the birth. An episiotomy provides adequate space for the safe use of these instruments, reducing the risk of complications for both mother and baby.
Risks and Complications
The risks and complications associated with episiotomies during childbirth are –
Postpartum Pain Increase: Episiotomies can be painful and take a long time to heal, sometimes even longer than normal tears.
Infection Risk: The cut could get infected, especially if proper cleanliness and wound care procedures are not followed.
Impact on Pelvic Floor Function: Despite what some people thought before, regular episiotomies don't always keep the pelvic floor muscles working, and they may even make problems worse.
Severe Tearing: A midline episiotomy could turn into a fourth-degree tear, which would affect the anal sphincter and rectal tissue and could cause faecal incontinence.
Alternatives to Episiotomy
Some of the alternatives to episiotomy are –
Perineal Massage: Massages of the perineum regularly during pregnancy can help make the skin more flexible and lower the risk of tears or the need for an episiotomy.
Supportive Pregnant Labour Positions: Certain positions, such as squatting or lying on one’s side, can reduce perineal stress and lower the risk of tearing.
Techniques for Controlled Delivery: Healthcare professionals can slow down the delivery of the baby's head to let the perineal muscles stretch over time. It avoids the need of episiotomy.
Clinical Guidelines and Recommendations
Here are the essential rules and suggestions for using episiotomies in maternity care –
WHO Episiotomy Guidelines: The World Health Organisation recommends decreasing regular episiotomies and emphasising patient-specific therapy. Their guidelines focus on natural childbirth and use episiotomy only when clinically required.
The ACOG Episiotomy Standards: The ACOG opposes regular episiotomies. They recommend episiotomy only when medically necessary. This strategy promotes safer, more natural delivery and reduces unneeded surgery.
Patient Education and Decision-Making
Patients must make episiotomy decisions with complete, evidence-based information. Therefore, educating pregnant women about the procedure's risks and advantages encourages active involvement in their birth plans, improving maternal care and autonomy.
During prenatal visits, it’s crucial for pregnant women to discuss the possibility of an episiotomy with their healthcare provider. This conversation helps them understand the procedure and its purpose and to express their preferences for labour and delivery.
Also, before the labour begins, doctors must inform pregnant women of the risks, advantages, and alternatives to episiotomies. Informed consent empowers patients to make birthing decisions.
Having said that, keeping a prior birth plan is vital, but patients should be flexible. The need for an episiotomy or other medical treatment during childbirth might be unanticipated, so expecting mothers and family members need to be adaptable and make the right decision.
Recovery and Care after Episiotomy
Here are some ideas about how to heal and take care of someone who has had an episiotomy during childbirth –
Episiotomy Wound Postpartum Care
Maintaining a clean wound, applying cold packs to minimise swelling, and avoiding severe strain are all important components of proper wound care.
Suggestions for Dealing with Pain
Pain treatment may comprise the use of prescription drugs and sitz baths for comfort.
Keeping an Eye Out For Problems
Keeping an eye out for symptoms of infection, such as redness, swelling, or discharge, and getting in touch with a medical professional if any of these symptoms appear is of utmost importance.
Returning To Normal Life
Based on their healing capacity and doctor's advice, mothers can gradually resume daily activities.
Conclusion
Episiotomy, once a routine childbirth procedure, is now performed selectively based on medical necessity. While it can aid complex deliveries, it also carries risks. Expectant mothers should educate themselves on its benefits, risks, and alternatives. Open discussions with healthcare providers and informed decision-making empower women to achieve safer, more comfortable birthing experiences.
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