Episiotomy and Perineal Tears
Overview
An episiotomy (say
"eh-pih-zee-AH-tuh-mee") is a cut the doctor or midwife makes in the
perineum (say "pair-uh-NEE-um"), which is the area
between the
vagina and anus. It is done to help deliver the baby
or to help prevent the muscles and skin from tearing.
The cut is
made just before the baby's head comes out of the birth canal. It is stitched
up after the birth.
When is an episiotomy needed?
There are times when
an episiotomy is needed—for example, if the baby's heart rate drops too much during
pushing or if the baby's position is causing problems. The decision cannot be
made until delivery. Episiotomies are more common with first-time deliveries.
Routine episiotomy is not recommended.
Experts say that episiotomy:1
- Usually is not needed, especially during
routine births.
- Does not tend to heal faster than a perineal tear.
And it often causes more pain.
- Can cause more damage to the muscles
around the vagina and rectum than a tear does.
In the past, episiotomy was a very common part of
childbirth. Many doctors no longer do episiotomies routinely. But a few still
do. If you have a concern about this, talk to your doctor or midwife ahead of
time.
Can you prevent perineal tears?
It's not uncommon
for the perineum to tear during birth. But there are steps you can take to help
prevent this:3, 2
- Pay attention to your position during labor.
Different positions may put less pressure on your perineum. You may feel more
comfortable sitting upright, lying on your side, or getting down on your hands
and knees, for example.
- Avoid having anyone push down on your
belly to speed up delivery. To keep from tearing, your perineum needs to
stretch slowly and gently.
- Talk to your birthing coach ahead of
time so you agree on when and how hard you should push.
- Have
someone provide perineal support. This means pushing against the perineum to
protect it from tearing as the baby's head stretches it. This is sometimes done
with a hot, moist cloth.
- Do
Kegel exercises in the months before childbirth. These
can strengthen your pelvic muscles.
- Practice perineal massage.
This type of massage makes the tissue around the vagina more flexible. Some
studies show that women who massage this area daily during the last part of
their pregnancy are less likely to have tearing.2
References
Citations
- Agency for Healthcare Research and Quality (2005).
The Use of Episiotomy in Obstetrical Care: A Systematic Review. Evidence Report/Technology Assessment No. 112. Available online:
http://www.ahrq.gov.
- Beckmann MM, Garrett AJ (2006). Antenatal perineal
massage for reducing perineal trauma. Cochrane Database of Systematic Reviews (1).
- Viswanathan M, et al. (2005). The Use of Episiotomy in Obstetrical Care: A Systematic Review. Evidence
Report/Technology Assessment No. 112 (AHRQ Publication No. 05-E009-1).
Rockville, MD: Agency for Healthcare Research and Quality.
Other Works Consulted
- American College of Obstetricians and Gynecologists
(2006). Episiotomy. ACOG Practice Bulletin No. 71. Obstetrics and Gynecology, 107(4): 957–962.
- Kettle C, Tohill S (2008). Perineal care, search date April 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Kirtly Jones, MD, MD - Obstetrics and Gynecology |
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| Last Revised | January 7, 2010 |
|---|
Last Revised:
January 7, 2010
Agency for Healthcare Research and Quality (2005).
The Use of Episiotomy in Obstetrical Care: A Systematic Review. Evidence Report/Technology Assessment No. 112. Available online:
http://www.ahrq.gov.
Beckmann MM, Garrett AJ (2006). Antenatal perineal
massage for reducing perineal trauma. Cochrane Database of Systematic Reviews (1).
Viswanathan M, et al. (2005). The Use of Episiotomy in Obstetrical Care: A Systematic Review. Evidence
Report/Technology Assessment No. 112 (AHRQ Publication No. 05-E009-1).
Rockville, MD: Agency for Healthcare Research and Quality.
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