The Need to Avoid the Routine Use of Episiotomy

Abstract

The justification of the routine use of the episiotomy arose at the beginning of 20 th century. It was based on personal beliefs without scientific basis that endorsed this recommendation. This led to the incorporation of episiotomy in daily practice being a routine procedure, especially in nulliparous women. Since 1985 many researches of good experimental design were generated to verify if routine episiotomy was justified.High-quality methodological studies gave strong evidence that the episiotomy should not be done routinely in view of the fact that it does give benefits neither for the women nor for the newborns. Its use should be restricted to certain clinical situations.However, the episiotomy continues to be a customary practice even though the available evidence for more than one decade ago shows that it does not improve maternal or perinatal health. This suggests that there is a need for implementing interventions to change practitioner's behaviour.

Sexual function in women after delivery: Does episiotomy matter?

“…Despite the controversy regarding the validity of episiotomy's routine use in obstetrics, this is still one of the most performed procedures worldwide [2][3][4].…”

The place of episiotomy in history: A sore review

“…At this time prevailed a protective model of care, in which manual dilate or stretch of tissues was classified as an error and assumed to be the source of genital damage. [4,7] • In the 18th century only a few midwives wrote about their knowledge and expertise. At the same time, since 1700, there has been a significant increase in the male figure during childbirth (man-midwife) and the surgical model begins to appear more and more in technical treaties • In the 19th century it was verified the abandonment of home as birth place and women started to be transferred to the hospital -an influential factor in this paradigmatic change.…”

“…[9] It was indiscriminately settled an invasive procedure, devoid of scientific scrutiny. [7,10] Six decades after, it was accurated the first rate of episiotomy use in the USA: 65.1% in 1979 and 64% in 1989. [2,10] Episiotomy practice has become so obsessive that it has materialized in a mandatory rule.…”

“…[24,25] It is true that episiotomy still occupies a prominent place in the obstetrical practice and despite being an invasive procedure women are not adequately informed, of pros and cons, and their consent or dissent is rarely obtained. [20,26] Experts in this area affirm that today the most influential primary factor in the occurrence of an episiotomy are not the characteristics of the parturient, but the characteristics and beliefs of the professional, [1,7,19,24,27] and midwives are the professionals who have the lowest rate of its execution. [13,28] Currently, with the re-emergence of perineal preservation care, we see the dichotomy between the social model and the surgical model: one more adopted by midwives, the other by doctors.…”

“…The research and implementation of guidelines by themselves are indicated as insufficient to achieve change, so it is imperative to explore praxis and analyse what is practiced for being necessary and what is practiced based on personal beliefs or even for convenience. [1,7] In order to facilitating the change of habits during birth assistance and reducing the number of episiotomies practiced, several suggestions appear in the literature: [7,8,12,13,23,25,32] • additional training in perineal management during initial nursing-midwifery education programmes…”