Start perineal massage at 36 weeks Alleviate fear and anxiety Facilitate occiput anterior presentations Eliminate midline episiotomy
Observational evidence overwhelmingly shows that midline episiotomy
is strongly associated with obstetric anal sphincter injury.
Results for restrictive versus routine mediolateral versus midline episiotomy
were similar to the overall comparison.
In 33 years of practice, I have not encountered rectovaginal fistula or anal incontinence among my patients who have a midline episiotomy
was the most significant independent risk factor for severe perineal tearing, with an odds ratio (OR) of 6.
Allowing the patient to tear is an acceptable alternative to performing an unnecessary small midline episiotomy
raises the risk for postpartum anal incontinence independently of its association with instrument-assisted delivery high birth weight, and long labor, Boston investigators reported.
After adjusting for parity, type of birth attendant physician or midwife), location of delivery (delivery room or labor bed), birthweight, and ethnicity, women with a midline episiotomy
Kilpatrick found that midline episiotomy
significantly increases the risk of third- and fourth-degree tears, while mediolateral episiotomy offers no protection.
The clinical protocol resulted in more women assigned to mediolateral episiotomy (n = 244) than to the midline episiotomy
(n = 159), but the two groups were well matched on such major clinical characteristics as age, gestational age at delivery, duration of the second stage, rate of operative delivery, and anesthesia used.
Good, dense regional anesthesia combined with an empty bladder, liberal use of a lubricant, a midline episiotomy
, and (critically) proper application, will nearly always result in a easy; atraumatic birth.
A 28-year-old primigravida undergoes a forceps delivery with a midline episiotomy
for failure to progress in the second stage of labor.