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Medio-lateral episiotomy as baby crowns. An episiotomy / pizitmi/ is a surgical incision through the perineum made to enlarge the vagina and assist childbirth. The incision can be midline or at an angle from the posterior end of the vulva, is performed under local anaesthetic and is sutured closed after delivery. It is one of the most common medical procedures performed on women, and although its routine use in childbirth has steadily declined in recent decades, it is still widely practised in Latin America.
Uses
Many physicians use episiotomies because they believe that it will lessen perineal trauma, minimize postpartum pelvic floor dysfunction by reducing anal sphincter muscle damage, reduce the loss of blood at delivery, and protect against neonatal trauma. In many cases though, episiotomies cause all of these problems. Research has shown that natural tears typically are less severe. Episiotomies may be indicated if:
there is any sign of fetal distress while the baby is in the birth canal a delivery occurs too quickly for the vagina to stretch naturally the baby's head is too large for the opening the baby's shoulders are stuck (When a baby's shoulders are stuck they are stuck behind bony pelvis, not soft tissue, so this indication is disputed) it is a breech birth or forceps delivery
Informed consent
Expectant mothers frequently make "birth plans" during their antenatal care, and are generally encouraged to discuss their views on episiotomy with their carers, or as early as possible in labour. In the final stages of delivery the midwife or obstetrician may not have time to discuss the benefits, risks and alternatives without endangering the mother or baby. However, staff restrictions or complications in labour often mean that these plans have to be altered in the course of the birth.
Avoidance
Perineal massage with Vitamin E oil or pure vegetable oil beginning around the 34th week is an unproven way to make the perineum more flexible and reduce the need for episiotomy. Controlled delivery of the head that allows slow gradual stretching of the perineal tissue can help in minimising damage to the perineum. In some cases an episiotomy may be required if the perineum can't stretch sufficiently and is required to help minimise damage to the anal sphincter. If the tissue is stretching, some studies suggest that small natural tears heal quicker and are less painful, so a tear is preferrable to an episiotomy.