Current approach to episiotomy: Inevitable or unnecessary?

Abstract

<jats:title>Abstract</jats:title><jats:p>An episiotomy is a surgical incision through the perineum made to provide sufficient area for the delivery of the infant. About 10 to 95% of women who deliver will have episiotomy depending on which part of the world they are having delivery.</jats:p><jats:p>Too early episiotomy causes extensive bleeding and too late episiotomy causes the excessive stretching of a pelvic floor and lacerations could not be prevented.</jats:p><jats:p>According to widely accepted arguments, there are many benefits of episiotomy for the neonate: prevention of injuries, shoulder dystocia and mental retardation of the infant. Benefits for the mother are: reduction of severe lacerations, prevention of sexual dysfunction, prevention of urinary and fecal incontinence. But those things could also be complications of episiotomy, if it is being used nonrestrictively. Some other complications are also extensive bleeding, hematoma or infection.</jats:p><jats:p>There are many different opinions in literature about using episiotomy restrictively or routinely, so it is the right doubt arisen: is it inevitable or unnecessary?</jats:p><jats:p>There is a wide variation in episiotomy practice, and the decision of performing it or not depends of actual clinical situation.</jats:p><jats:p>There is still a great need for continuous obstetrics education according to the evidence based guidelines for the patient’s safety.</jats:p>

Prevalence and Factors Associated With Episiotomy in Shahroud City, Northeast of Iran

“…According to the data of World Health Organization (WHO) and World Bank, in 2002 wars had been among the first ten reasons which killed the most and caused disabilities. Civil losses are at the rate of 90% within all losses (1). War has many negative effects on human health.…”

Incidence of episiotomy in Slovenia: The story behind the numbers

“…Episiotomy was introduced in the practice of midwifery and obstetrics in the middle of the 18th century, without strong scientific evidence of its benefits (Lede et al, ). The wide use of episiotomy in the early 20th century was concurrent with the move of births from home to hospital and a greater involvement of obstetricians in maternal care (Jovanovic et al, ). Gradually, episiotomy became a routine procedure in several countries, despite strong evidence questioning its usefulness (Jovanovic et al, ).…”

“…The wide use of episiotomy in the early 20th century was concurrent with the move of births from home to hospital and a greater involvement of obstetricians in maternal care (Jovanovic et al, ). Gradually, episiotomy became a routine procedure in several countries, despite strong evidence questioning its usefulness (Jovanovic et al, ). During 1995–2003 the number of episiotomies was still high in many European countries.…”

“…In 2002, episiotomy rates exceeded 40% in Germany, France, and Switzerland (Graham et al, ). According to Jovanovic et al (), the main aim of episiotomy is the prevention of severe perineal trauma that can lead to anal sphincter injuries. Steen and Roberts () recommend that episiotomy should only be practised when fetal distress is indicated.…”

“…The majority of women who have a vaginal birth will sustain perineal trauma from a spontaneous perineal tear or episiotomy, or both (Royal College of Midwives, ). Episiotomy is defined as a deliberate incision made through the perineal body to enlarge the vaginal orifice during the second stage of labor to enable easier and faster expulsion of the presenting part of the fetus (Jovanovic et al, ). According to the European Perinatal Health Report (Euro Peristat, ) and Lurie et al (), episiotomy is still one of the most frequent surgical interventions performed during childbirth, despite a lack of evidence supporting the maternal benefits traditionally ascribed to the procedure.…”