Childbirth: When an episiotomy is required?

Childbirth

There was a time when an episiotomy was almost systematically performed during childbirth. This is no longer the case today, but it would be possible to further reduce the frequency of this gesture.

The episiotomy consists of incising the superficial muscles of the perineum by a few centimeters, in order to avoid a serious tear, which can, in particular, affect the anal sphincter.

According to figures from 2014, an episiotomy was performed in 35% of women who gave birth. Conventionally, this surgical procedure is performed in three situations.

• Fetal distress. The baby’s expulsion must be accelerated by the administration of oxytocin, but the perineum does not have time to distend naturally.

• Difficult delivery. The baby is too big or it comes by the seat: it must be made room.

• Special maneuvers. The obstetrician must use instruments (forceps or suction cup).

The episiotomy is not neutral. It can in particular lead to an increase in pain and the healing time compared to a simple perineal tear, and complicates the resumption of sex life. In this context, the National College of French Gynecologists and Obstetricians / College National des Gynecologues et Obstetriciens Francais (CNGOF) has issued recommendations where the only obvious indication for an episiotomy refers to the use of extraction instruments during childbirth, in order to speed up the delivery.

When his head is blocked, when the mother is tired, or when the fetal heart rate is severely abnormal, that said, each obstetrician, during each delivery, will assess the situation. An episiotomy is difficult to program, and it is decided at the last moment, with some urgency. It is nevertheless important to inform mothers of this possibility and to collect their opinion when an episiotomy is envisaged (high probability, etc.). It is certain that the opinion of the CNGOF will not be unanimous, and this is understandable, but at least it provides food for thought.

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