Episiotomy (cont.)

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How common is episiotomy?

An episiotomy is performed in about 40% of vaginal deliveries in the United States, but the prevalence of episiotomy has been decreasing in recent years. For example, 1.6 million episiotomies were performed in 1992 and only 716,000 in 2003. Some countries have significantly lower episiotomy rates than the U.S. In general, episiotomy is less common in Europe than in the U.S.

How is an episiotomy done?

The usual cut (incision) for an episiotomy goes straight down and typically does not involve the muscles around the rectum or the rectum itself. Anesthesia in the form of nerve blocks or local injections of anesthetic are given if the patient has not received regional anesthesia (such an epidural) for the delivery.

What are the advantages of an episiotomy?

An episiotomy can decrease the amount of pushing the mother must do during delivery. It can also decrease trauma to the vaginal tissues and expedite delivery of the baby when delivery is necessary quickly. Doctors who favor episiotomies argue that a surgical incision is easier to repair than a spontaneous irregular or extensive tear, and is likely to lead to a more favorable outcome with fewer complications.

How is an episiotomy repaired?

The repair is straightforward and is fairly simple to perform. The incision is repaired by suturing (sewing) the wound together.

What are the possible complications of an episiotomy, and should an episiotomy be part of a routine delivery?

Episiotomy can be associated with extensions or tears into the muscle of the rectum or even the rectum itself. Other complications can include:

  • bleeding,
  • infection,
  • swelling,
  • defects in wound closure,
  • local pain, and
  • a short-term possibility of sexual dysfunction.

Studies have shown conflicting results regarding the question of whether performing an episiotomy results in greater postpartum pain than not performing the procedure.

However, it is important to note that if the baby needs to be delivered more urgently, then waiting for the mother to push it out without the assistance of an episiotomy may in certain cases cause harm to the fetus. Also, there are some tears that occur when no incision is made that are very difficult to repair and cause greater blood loss than might otherwise occur.

The American College of Obstetricians and Gynecologists supports the position of restricted, instead of routine, use of episiotomy. Instead, episiotomy should be considered in certain situations when there is a high risk of severe lacerations or the need to facilitate rapid delivery of a fetus.

What is the healing time for an episiotomy?

The typical healing time for an episiotomy is around 4 to 6 weeks depending on the size of the incision and the type of suture material used to close the wound.

Last Editorial Review: 12/9/2008