episiotomy

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Related to episiotomies: midline episiotomy

Episiotomy

 

Definition

An episiotomy is a surgical incision made in the area between the vagina and anus (perineum). This is done during the last stages of labor and delivery to expand the opening of the vagina to prevent tearing during the delivery of the baby.

Purpose

This procedure is usually done during the delivery or birthing process when the vaginal opening does not stretch enough to allow the baby to be delivered without tearing the surrounding tissue.

Precautions

Prior to the onset of labor, pregnant women may want to discuss the use of episiotomy with their care providers. It is possible that, with adequate preparation and if the stages of labor and delivery are managed with adequate coaching and support, the need for an episiotomy may be reduced.

Description

An episiotomy is a surgical incision, usually made with sterile scissors, in the perineum as the baby's head is being delivered. This procedure may be used if the tissue around the vaginal opening begins tearing or does not seem to be stretching enough to allow the baby to be delivered.
In most cases, the physician makes a midline incision along a straight line from the lowest edge of the vaginal opening to toward the anus. In other cases, the episiotomy is performed by making a diagonal incision across the midline between the vagina and anus. This method is used much less often, may be more painful, and may require more healing time than the midline incision. After the baby is delivered through the extended vaginal opening, the incision is closed with stitches. A local anesthetic agent may be applied or injected to numb the area before it is sewn up (sutured).
Several reasons are cited for performing episiotomies. Some experts believe that an episiotomy speeds up the birthing process, making it easier for the baby to be delivered. This can be important if there is any sign of distress that may harm the mother or baby. Because tissues in this area may tear during the delivery, another reason for performing an episiotomy is that a clean incision is easier to repair than a jagged tear and may heal faster. Although the use of episiotomy is sometimes described as protecting the pelvic muscles and possibly preventing future problems with urinary incontinence, it is not clear that the procedure actually helps.
The use of episiotomy during the birthing process is fairly widespread in the United States. Estimates of episiotomy use in hospitals range from 65-95% of deliveries, depending on how many times the mother
An episiotomy is a surgical incision made in the perineum, the area of tissue between the vaginal opening and the anus, during the birthing process. This procedure may be used if the tissue around the vaginal opening begins to tear or is not stretching enough to allow the baby to be delivered vaginally. In the United States, the rate of episiotomies being performed is estimated at 65-95%.
An episiotomy is a surgical incision made in the perineum, the area of tissue between the vaginal opening and the anus, during the birthing process. This procedure may be used if the tissue around the vaginal opening begins to tear or is not stretching enough to allow the baby to be delivered vaginally. In the United States, the rate of episiotomies being performed is estimated at 65-95%.
(Illustration by Electronic Illustrators Group.)
has given birth previously. This routine use of episiotomy is being reexamined in many hospitals and health care settings. However, an episiotomy is always necessary during a forceps delivery because of the size of the forceps.

Preparation

It may be possible to avoid the need for an episiotomy. Pregnant women may want to talk with their care providers about the use of episiotomy during the delivery. Kegel exercises are often recommended during the pregnancy to help strengthen the pelvic floor muscles. Prenatal perineal massage may help to stretch and relax the tissue around the vaginal opening. During the delivery process, warm compresses can be applied to the area along with the use of perineal massage. Coaching and support are also important during the delivery process. A slowed, controlled pushing during the second stage of labor (when the mother gets the urge to push) may allow the tissues to stretch rather than tear. Also, an upright birthing position (rather than one where the mother is lying down) may decrease the need for an episiotomy.

Aftercare

The area of the episiotomy may be uncomfortable or even painful for several days. Several practices can relieve some of the pain. Cold packs can be applied to the perineal area to reduce swelling and discomfort. Use of the Sitz bath available at the hospital or birth center can ease the discomfort, too. This unit circulates warm water over the area. A squirt bottle with water can be used to clean the area after urination or defecation rather than wiping with tissue. Also, the area should be patted dry rather than wiped. Cleansing pads soaked in witch hazel (such as Tucks) are very effective for cleaning the area and also feel soothing.

Risks

Several side effects of episiotomy have been reported, including infection, increased pain, prolonged healing time, and increased discomfort once sexual intercourse is resumed. There is also the risk that the episiotomy incision will be deeper or longer than is necessary to permit the birth of the infant. There is a risk of increased bleeding.

Normal results

In a normal and well managed delivery, an episiotomy may be avoided altogether. If an episiotomy is deemed to be necessary, a simple midline incision will be made to extend the vaginal opening without additional tearing or extensive trauma to the perineal area. Although there may be some pain associated with the healing of the episiotomy incision, relief can usually be provided with mild pain relievers and supportive measures, such as the application of cold packs.

Abnormal results

An episiotomy incision that is too long or deep may extend into the rectum, causing more bleeding and an increased risk of infection. Additional tearing or tissue damage may occur beyond the episiotomy incision, leaving a cut and a tear to be repaired.

Resources

Other

Childbirth.org. http://www.childbirth.org.

Key terms

Kegel exercises — A series of contractions and relaxations of the muscles in the perineal area. These exercises are thought to strengthen the pelvic floor and may help prevent urinary incontinence in women.
Perineum — The area between the opening of the vagina and the anus in a woman, or the area between the scrotum and the anus in a man.
Sitz bath — A shallow tub or bowl, sometimes mounted above a toilet, that allows the perineum and buttocks to be immersed in circulating water.
Urinary incontinence — The inability to prevent the leakage or discharge of urine. This situation becomes more common as people age, and is more common in women who have given birth to more than one child.

episiotomy

 [ĕ-piz″e-ot´ah-me]
surgical incision into the perineum and vagina for obstetrical purposes. The incision is repaired by perineorrhaphy.
Types of episiotomy. From McKinney et al., 2000.

ep·i·si·ot·o·my

(e-piz'ē-ot'ŏ-mē),
Surgical incision of the vulva to prevent laceration at the time of delivery or to facilitate vaginal surgery.
Synonym(s): vaginoperineotomy
[episio- + G. tomē, incision]

episiotomy

/epis·i·ot·o·my/ (e-piz″e-ot´ah-me) surgical incision into the perineum and vagina to prevent traumatic tearing during delivery.

episiotomy

(ĭ-pĭz′ē-ŏt′ə-mē, ĭ-pē′zē-)
n. pl. episioto·mies
Surgical incision of the perineum during childbirth to facilitate delivery.

episiotomy

[epē′zē·ot′əmē]
Etymology: Gk, episeion, pubic region, temnein, to cut
a surgical procedure in which an incision is made in a woman's perineum to enlarge her vaginal opening for delivery. It is performed most often electively to prevent tearing of the perineum, to hasten or facilitate birth of the baby, or to prevent stretching of perineal muscles and connective tissue thought to predispose to subsequent abnormalities of pelvic outlet relaxation, as cystocele, rectocele, and uterine prolapse. Its prophylactic efficacy is debated. It is usually required for a forceps delivery. The incision into the vaginal and perineal tissue is closed with absorbable sutures that need not be removed. Deep incisions require closure in two or more layers. Immediate complications include hemorrhage and extension of the incision along the vaginal sulcus or into the anal sphincter or rectum. Delayed complications include hematoma and abscess. Application of cold packs to the perineum for several hours immediately after delivery minimizes swelling. Later alternating applications of heat and cold and warm sitz baths reduce discomfort, but sitz baths longer than 10 minutes soften tissue and prolong healing time. A mediolateral episiotomy is an episiotomy cut at an angle of approximately 45 degrees with the midline. Although it affords wide exposure for delivery, it is painful after delivery and is prone to hematoma and infection. A median or midline episiotomy is an incision in the perineum in the midline; although less painful after delivery, it affords less exposure for delivery and may extend into or through the anal sphincter and into the rectum.

episiotomy

Obstetrics An incision at the introitus performed at the end of the second stage of labor to facilitate delivery and to avoid jagged perineal tears

ep·i·si·ot·o·my

(e-piz'ē-ot'ŏ-mē)
Surgical incision of the vulva to prevent laceration at the time of delivery or to facilitate vaginal surgery.
[episio- + G. tomē, incision]

episiotomy

A deliberate cut made during childbirth in the margin of the vaginal opening so as to enlarge it, facilitate delivery of the baby and prevent tearing of the tissues backwards towards the anus.

episiotomy

surgical incision into the perineum and vagina for obstetrical purposes.
References in periodicals archive ?
We chose to extract these data after having explored with the obstetricians what medical information led them to perform episiotomies.
Epidurals and inductions are also used less frequently than average - but Bronglais staff carry out episiotomies more often than any other Welsh hospital apart from Glan Clwyd.
More recently, a study by Repke of Nebraska in collaboration with colleagues at the Brigham and Women's Hospital in Boston reviewed cases of 600 new mothers and found that the women who had episiotomies had an increased risk of intestinal problems for as long as 6 months after delivery.
Starting in 2014, The Joint Commission will publish hospital rates for cesarean sections and episiotomies, but not rates for individual doctors.
When elective cesarean surgery is compared to a style of obstetric management that has been shown to be harmful -- including unnecessary episiotomies, forceps and vacuum deliveries -- it gives the false appearance of equivalent risk between surgical and vaginal birth.
The use of episiotomies fell 60% between 1997 and 2008, but cesarean sections rose 72%, according to data released by the Agency for Healthcare Research and Quality.
Interestingly, however, episiotomies do not appear to contribute to this problem.
A recent review of scientific studies confirms what childbirth advocates have long known: routine use of episiotomies does not benefit laboring women.
Stretch Oil can also be added to a warm bath or used for perineal massage to prevent tears and episiotomies during childbirth.
However, according to scientific evidence, routine episiotomies damage vaginal structures rather than protect them.
The results of the program were associated with a median 45% reduction in mild postpartum hemorrhages (500-1,000 mL blood loss), a 70% reduction in severe postpartum hemorrhages (1,000 mL or greater), a median 122-mL decrease in postpartum blood loss, and a 20% decrease in second-degree perineal tears and episiotomies in the hospitals randomized to the intervention, compared with the control hospitals, Dr.
That said, episiotomies are needed in some cases, and sometimes wound dehiscence requires additional repair, said Dr.