Episiotomy confers no benefits

Posted on:

Wednesday, December 10th 2014 at 11:30 am

Written By:

Judy Cohain, CNM

Episiotomy confers no benefits. The most effective way to prevent perineal damage is to avoid episiotomy. Episiotomy, albeit rarely, has resulted in the death of the woman from necrotizing fasciitis.
Episiotomy increases all the bad outcomes it was supposed to prevent. In a 1983 review of episiotomy during the years 1860-1980, this review found that episiotomy has no benefits and causes more 3rd and 4th degree tears, more short and long term fecal incontinence, more bleeding, more pain, and more short and long term sexual discomfort than not cutting an episiotomy. (1)
Most fecal incontinence is a result of damage caused by an episiotomy. (2)  A previous episiotomy is the biggest risk factor for perineal damage on subsequent births - 55% of women who had previously had an episiotomy needed to be sutured at subsequent births. (3)
The World Health Organization recommends episiotomy for the following indications only, but none of them are backed up by evidence:

1. Fetal distress in the second stage of labor, to speed up the delivery of the baby - The truth is that episiotomy is not performed until the head is crowning and about to emerge because before that it would result in life threatening postpartum hemorrhage.  True fetal distress does not develop suddenly in the last 5 minutes as the head is about to emerge. The fetal heart may go down while the mother holds her breath to push.  If the baby has had a reassuring heart beat until crowning, there is plenty of time for the fetus to recover a normal heart beat between contractions, by encouraging the woman to breathe normally.
2. Previous third or fourth degree tear - The opposite is true. Episiotomy increases anal damage. (2) Women with previous severe tear can prevent repeat tears by stretching the scar tissue with EPINO birth trainer before birth.
3. Complicated vaginal delivery, e.g. shoulder dystocia, breech, forceps or vacuum deliveries - No evidence for this. An episiotomy just makes a lot of bleeding so you cannot see what you are doing with shoulder dystocia, breech, forceps and vacuum births.  Delivery of the head is not delayed by the perineum, but by the pelvic bones, so cutting an episiotomy does not speed up the birth and may delay it because of the bloody mess.
4. Maternal stress due to exhaustion or heart failure - Think about it.  The woman carried the baby for 9 months and went thru hours of labor, but suddenly WHO justifies making a deep cut to save 5 minutes?  She will push for an extra 5 minutes if you just tell her that it will prevent 10 days of pain from an episiotomy and a 1% risk of permanent incontinence of feces.
5. A very tight perineum that prevents delivery - Where the fetal heart is reassuring there is no rush.  The perineum will stretch eventually if one waits patiently.

   ----------------------------------------------------------------------------

  *** Does this make any of you feel better???