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Perineal damage and Episiotomy

Damage to the perineum , the skin between the vagina and anus, is one of the traumas most frequently suffered by women during delivery , even during labour and delivery that are considered normal .
Perineal tears are divided into first-degree (sometimes do not even need to be sutured), second-degree tears (usually can be sutured easily under local analgesia , generally healing without complications) and third-degree tears . Third-degree tears can produce more serious consequences such as faecal incontinence and/or faecal fistulas and thus should be well attended to by an obstetrician.

An episiotomy is an incision through the perineum and the vaginal wall. In the USA they are carried out on between 50 - 90% of women giving birth to their first child, thus making the episiotomy the most commonly performed surgical procedure in that country. There are 2 types: Midline episiotomies are more easily sutured and have the advantage of leaving less scar-tissue, whilst mediolateral episiotomies more effectively avoid the anal sphincter and the rectum.

According to the WHO good reasons for performing an episiotomy during a normal delivery include:

  • Signs of foetal distress.
  • Insufficient progress of delivery, i.e. slow labour .
  • Threatened third-degree tear, which includes having had a third-degree tear in a previous delivery.

The benefits of liberal episiotomy use in deliveries are suggested (although much debated) to include:

  • A episiotomy is easier to repair and heals better than a tear.
  • Liberal use of episiotomy prevents serious perineal trauma.
  • Episiotomies prevent trauma to the foetal head.
  • Episiotomies prevent trauma to the muscles of the pelvic floor, and thus prevent urinary stress incontinence.

However, no real evidence exists to support such suggested benefits.

For further, more detailed information on this topic, please refer to the reference source for this page.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Care in Normal Birth: A Practical Guide. Report of a Technical Working Group, World Health Organisation, Department of Reproductive Health and Research, 1999.

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