Friday, October 16, 2009

Myth vs. Reality: Episiotomy

I'm not going to do anything in the way of my own writing, since this basically speaks for itself. You can't always believe your doctor.

Myth: A nice clean cut is better than a jagged tear.

Reality: "Like any surgical procedure, episiotomy carries a number of risks: excessive blood loss, haematoma formation, and infection. . . . There is no evidence . . . that routine episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents fetal trauma or reduces the risk of urinary stress incontinence." Sleep, Roberts, and Chalmers 1989

Summary of Significant Points, from Henci Goer's Book, Obstetric Myths vs. Research Realities

>Episiotomies do not prevent tears into or through the anal sphincter or vaginal tears. In fact, deep tears almost never occur in the absence of an episiotomy.

>Even when properly repaired, tears of the anal sphincter may cause chronic problems with coital pain and gas or fecal incontinence later in life. In addition, anal injury predisposes to rectovaginal fistulas.

>If a woman does not have an episiotomy, she is likely to have a small tear, but with rare exceptions the tear will be, at worst, no worse than an episiotomy.

>Episiotomies do not prevent relaxation of the pelvic floor musculature. Therefore, they do not prevent urinary incontinence or improve sexual satisfaction.

>Episiotomies are not easier to repair than tears.

>Episiotomies do not heal better than tears.

>Episiotomies are not less painful than tears. They may cause prolonged problems with pain, especially pain during intercourse.

>Episiotomies do not prevent birth injuries or fetal brain damage.

>Episiotomies increase blood loss.

>As with any other surgical procedure, episiotomies may lead to infection, including fatal infections.

>Epidurals increase the need for episiotomy. They also increase the probability of instrumental delivery. Instrumental delivery increases both the odds of episiotomy and deep tears.

>The lithotomy position increases the need for episiotomy, probably because the perineum is tightly stretched.

>The birth attendant's philosophy, technique, skill, and experience are the major determinants of perineal outcome.

>Some techniques for reducing perineal trauma that have been evaluated and found effective are: prenatal perineal massage, slow delivery of the head, supporting the perineum, keeping the head flexed, delivering the shoulders one at a time, and doing instrumental deliveries without episiotomy. (Others, such as perineal massage during labor or hot compresses have yet to be studied.)

>Independent of specifically contracting the pelvic floor muscles (Kegels), a regular exercise program strengthens the pelvic floor.


sasha said...

myth vs realty: Episotomy
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