What is an episiotomy? Is it systematic?

What is an episiotomy?

The episiotomy is an intervention which consists in incising the bottom of the vagina and the muscles of the perineum (group of muscles and ligaments located between the anus and the vagina to support the organs of the basin) during the childbirth, on 2,5 to 6 cm on average. The purpose of this procedure is to enlarge the vaginal orifice and to facilitate and accelerate the baby's exit, as well as to avoid serious spontaneous tears by preferring a clean cut, and to avoid organ descent or stress incontinence.

The incision is often made diagonally, but can also be lateral (to avoid anal tears) or vertical.

Once the delivery is over, it will be closed by stitches made with absorbable thread. This suture is also necessary if a natural tear occurs.

However, this procedure has many disadvantages, such as possible pain that can last several days or even weeks, swelling at the incision site, a risk of infection, significant blood loss, an increased risk of deep tearing of the perineum, or persistent pain during sexual intercourse. In addition, after delivery and until the scar closes, it must be rinsed and dried after each visit to the toilet.

Simple measures can therefore be taken to reduce the risk of tearing the perineum, such as pushing in a side-lying position, applying a warm compress to the perineum, applying pressure to the perineum to support it during pushing, and massaging the perineum.

Is episiotomy less common?

The episiotomy was put into practice 250 years ago, and was performed almost systematically, especially in the case of a first pregnancy. That is to say that it represented more than 50% of the deliveries at the beginning of the Nineties in France, and it was even 80% of the deliveries in the Eighties.

Today it is questioned, and less and less practiced in order to follow the recommendations stated by the French National College of Gynecologists and Obstetricians in 2005, which stipulates that the episiotomy should be practiced only in cases where it is necessary and not concern more than 30% of the deliveries.

In fact, in the 1980s, women's organizations in the United States and Canada called for an accurate evaluation of episiotomy. The study that appeared in 1984 showed that systematic episiotomy did not represent any benefit, neither for the baby, nor for its mother. Other studies have confirmed the facts by showing that a restrictive practice of episiotomy allowed an increased number of intact perineums, without having an increase in severe tears.

In the 90's, the WHO recommended that countries should not exceed a percentage of 20% of episiotomies during deliveries, and reduced this percentage to 10% afterwards, as is the case in Sweden, while France still has a rate of around 30%.

Episiotomy can be performed for the birth of large babies (more than 4 kg), babies who are "breech", when there is a need to use forceps, in case of obstetrical emergency, or if the mother's perineum is short and there is a threat of serious tearing.

Moreover, episiotomy must be performed with the consent of the pregnant woman. We therefore advise you to discuss with your doctor before the delivery in order to determine the circumstances in which he or she could perform an episiotomy.

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