What is an Episiotomy? Significance, needs and comparison with natural tearing during labor

What is an episiotomy?               

Episiotomy is basically a mild incision that is performed in the muscular region connecting the vagina with anus (this area is called perineum and is extremely sensitive to pain). The incision is made immediately prior to delivery in order to expand and enlarge the vaginal vault. This is done to ensure the safe delivery of fetal head by increasing the room for the passage of baby.

What is the significance of Episiotomy?

Doctor and practitioners usually perform episiotomies in order to improve the overall process of delivery by:

• Improving the speed of labor process
• Preventing the perineal tear
• Preventing fetal and maternal complications

The “clean” incision or a cut of an episiotomy actually nurse back in a matter of weeks as opposed to a perineal tear that heals improperly and affect the subsequent deliveries and sexual health. Many professionals and experts also believe that an episiotomy may help in preventing complications like incontinence of urine or feces in later ages. Episiotomy is especially indicated in primigravidas, primarily because a lot of these mothers have tight perineum and small vaginal vault that may interfere with the normal delivery process.

However, this does not suggest that an episiotomy has to be performed in every pregnancy. This is because unnecessary episiotomies affect the maternal health in short term and long term basis and the disadvantages over-weigh the potential benefits as concluded by a number of clinical trials and gynecological studies. As per this conclusion, the American Congress of Obstetricians and Gynecologists along with other healthcare professionals related to labor and delivery have finally agreed to a point that episiotomy should be avoided, whenever possible.

Statistics of Episiotomies in past few decades:

The occurrence of episiotomies has greatly decreased in the past few years due to proper management of early stages of labor. This can be explained by 2 out of 3 episiotomies performed in vaginal births in 1979 to about 1 in 5 in 2004. (In contrast the episiotomies that are being performed for forceps or vacuum-assisted deliveries are considerably increasing in incidence). Still the experts around the world think that the number of these cases taking place can be further reduced by proper management of labor.

Need of an episiotomy?

There are a number of cases and conditions in which an episiotomy may be helpful.

• If the size of your baby is large as compared to the vaginal vault, seen mostly in conditions like maternal gestational diabetes or post-term baby or if there is a family history of obesity.
• If your baby needs to be born as promptly and quickly as possible due to reason like decreasing heart rate showing  baby isn’t capable of handling the last critical minutes of labor well – an episiotomy will serve as an ultimate solution to expedite the delivery.
• Other conditions are fetal distress is marked by passage of meconium in the amniotic fluid and high blood pressure in mothers due to vigorous pushing.
• In primigravidas especially because the perineal ligaments are very stiff that interferes with the delivery of baby.
• Some doctors introduce episiotomy as a prophylactic procedure to avoid tear in cases when the uterine contractions are not very strong and there may be a need for instrumental delivery.

A brief comparison of episiotomy and natural tearing during labor process:

Researcher has reached to a conclusion that women with natural or spontaneous tears in general respond better than women who underwent episiotomy.  Natural tearing heals in comparatively lesser time and often with mild complications and problems compared to those with a planned episiotomy performed in hands of an inexperienced practitioner.

Women who underwent episiotomy incision are likely to lose more amount of blood at the time of delivery and may also go through more intense pain during recovery and healing process. Moreover, they may have to extend their wait longer, before they have pain-free intercourse. It has been observed that episiotomy also raises the risk of illness with a longer period of recovery and a current study and upgraded research showed that getting an episiotomy  done for a first vaginal birth is associated with scar dehiscence or scar rupture of previous episiotomy that may lead to extensive perineal tearing.

Lastly, in most cases it has been observed that women who underwent episiotomies may also develop perineal tears as a result of episiotomy extension during labor process. These serious tears increases the risk of perineal pain after the birth, and this necessitate a longer healing period, and also affect the integrity of pelvic floor. Tears extending up or beyond anal sphincters make mothers prone to develop anal incontinence, rectal prolapse, uterine prolapse and other issues later in the life due to a weak pelvic floor.

In conclusion, it can be suggested that in the absence of a clear-cut indication, episiotomy should be avoided; unless there is a risk to maternal or fetal well-being.