Episiotomies

Episiotomy
Intervention
Medio-lateral episiotomy as baby crowns.
Pronunciation	/əˌpiːziːˈɒtəmiː/ or /ɛˌpəsaɪˈɒtəmiː/
ICD-9-CM	73.6
MeSH	D004841
MedlinePlus	002920
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Episiotomy also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician during second stage of labor to quickly enlarge the opening for the baby to pass through. The incision, which can be done at a 90 degree angle from the vulva towards the anus or at an angle from the posterior end of the vulva (medio-lateral episiotomy), is performed under local anesthetic (pudendal anesthesia), and is sutured after delivery.

Its routine use is no longer recommended. Despite this it is one of the most common medical procedures performed on women. In the United States as of 2012 it was performed in 12% of vaginal births. It is still widely practiced in many parts of the world including Latin America, Poland, Bulgaria, India and Qatar.

Episiotomy is done in an effort to prevent against soft-tissue tearing which may involve the anal sphincter and rectum. Vaginal tears can occur during childbirth, most often at the vaginal opening as the baby's head passes through, especially if the baby descends quickly. Tears can involve the perineal skin or extend to the muscles and the anal sphincter and anus. The midwife or obstetrician may decide to make a surgical cut to the perineum with scissors or a scalpel to make the baby's birth easier and prevent severe tears that can be difficult to repair. The cut is repaired with stitches (sutures). Some childbirth facilities have a policy of routine episiotomy.

Specific reasons to do an episiotomy is unclear. Though indications on the need for episiotomy vary, and may even be controversial (see discussion below), where the technique is applied, there are two main variations. Both are depicted in the above image. In one variation, the midline episiotomy, the line of incision is central over the anus. This technique bifurcates the perineal body, which is essential for the integrity of the pelvic floor. Precipitous birth can also sever—and more severely sever—the perineal body, leading to long-term complications such as incontinence. Therefore, the oblique technique is often applied (also pictured above). In the oblique technique, the perineal body is avoided, cutting only the vagina epithelium, skin, and muscles (transversalius and bulbospongiosus). This technique aids in avoiding trauma to the perineal body by either surgical or traumatic means.