2023 Author: Anita Thornton | [email protected]. Last modified: 2023-11-27 18:44
Not so long ago, episiotomy was performed almost systematically, at all deliveries. What should we know about this declining practice?
Performed by the doctor at the time of the expulsion, the episiotomy is a surgical incision of the skin and muscles of the perineum (between the anus and the vagina), of approximately 2 to 6 cm. It is of course preceded by local anesthesia. Theoretically, it would prevent - or at least reduce - spontaneous tearing and incontinence after healing.
When (and why) should an episiotomy be performed?
Before, it was often recommended: if the opening of the vagina seemed too narrow, if the baby's head was large, in case of breech, for the delivery of twinsand whenever we needed tools (forceps, suction cup).
However, over the past 20 years, scientific evidence has denied the supposed benefits of episiotomy and the Society of Obstetricians and Gynecologists of Canada no longer recommends routine episiotomy.
Indeed, the intervention would tend to cause deeper tears than natural tears, and it is now proven that it does not reduce the risk of incontinence, at leastopposite. This is why episiotomy is nowadays performed only occasionally: for example when the perineum seems to be the only thing delaying birth, when baby seems to be in pain or when multiple tears are to be expected.
What are the risks of an episiotomy?
If the cut as such does not really cause pain, the consequences of the episiotomy are often more painful. It is necessary to sew, under local anesthesia, the cut skin with an absorbable thread (melting stitches). Unpleasant operation, of course. In addition, the hours following the procedure, the affected area is painful and sensitive. Both walking and sitting can be inconvenient for a few days. Risk of hemorrhage is also possible.
“Women who undergo an episiotomy tend to have more tissue tearing, more pain, more stitches and a longer recovery after birth,” says Dr. Walker, obstetrician at the Hospital of Ottawa and a scientist at the IRSO. While episiotomy can hasten childbirth, it should only be used if it is obstetrically necessary, i.e. when the he alth of the mother or child is at risk. »
A declining practice
The Quebec Public He alth Association reports that in Quebec, 20 years ago, episiotomy was performed in 70% of deliveries. In 2008-2009, we were talking about 19%, and we have every reason to believe that thisaverage has fallen further since.
It is important to note that while the intervention is no longer considered mandatory, it is still necessary in some cases.
I don't want an episiotomy
As we mentioned, the practice has been declining for several years now. To have peace of mind, it is best to discuss your fears and wishes with your doctor during monthly pregnancy monitoring appointments. Once in the delivery room, the time is not conducive to philosophical discussions! That being said, you will probably be asked at the onset of labor whether or not you allow the episiotomy. This way, you can clearly tell your specialist your position and focus on the baby's birth. Note that an episiotomy in a first delivery does not mean that the scenario will be the same for those who will follow.
Can episiotomy be prevented?
Hard to say, since no study has shown that perineal massage really makes a difference and reduces the risk of tearing during childbirth. But, since they are really not contraindicated either, on the contrary, and they are able to make us feel more confident during childbirth, it is good to get started. Some exercises can also soften the perineum, while promoting hip opening and flexibility. We also think of Kegel exercises.
During childbirth, we can apply hot compresses to relaxthe muscles of the perineum.
How to treat an episiotomy?
Good hygiene will make it easier for melting points to heal and disappear. Make sure that the perineal area is always clean and dry.
You can clean yourself using a telephone shower, which, in addition to cleaning the wound without causing irritation, will provide a gentle massage. Sitz baths are also indicated. In case of pain, you can apply wet compresses or ice locally. You can of course take painkillers.
If the pain persists, consult your doctor.
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