A Closer Look at the Episiotomy, Capstone Project Example

An episiotomy, or incision of the perineum at the base of a woman’s vagina at the time of a vaginal birth, is a routine procedure during the present day in the United States. There are an estimated 35% of women who had this procedure performed in 1999 (Center, 2005).

There have been questions raised about variations in technique, lack of consent at the time the episiotomy is actually being performed, and how often a certain physician is actually performing the procedure. The question intended in this review is this: Are women that have experienced vaginal deliveries who have midline or medio-lateral episiotomies compared to those without episiotomies at increased risk for perineal trauma, perineal pain, sexual dysfunction, and perineal sequelae such as incontinence and infection following delivery?

Based on research, in seven different publications describing use of the procedure during various circumstances, the outcome remained basically the same (Banta & Thacker, 1982; Levitt, 1986; Webb, 2002). Women in more restrictive-use groups had less perineal trauma and less need for post delivery suturing, less risk of complications with wound healing, and a higher likelihood at resuming sexual intercourse earlier than did the groups of women who had more liberal based procedures (Bland & Montgomery, 1939; Curtis, 1933; Edwards & Waldorf, 1984).

Several studies provided information concerning urinary incontinence and infections with regard to episiotomies (Bodner-Adler et al, 2001; Bodner-Adler et al, 2003). It was found that episiotomies had no effect with the regard to prevention of pelvic floor damage (Combs, Robertson, & Laros, 1990; Riskin et al., 2002; Shiono et al, 1990).

Given all of the research and studies, the procedure itself seems without great risks if it is done with some thought and not simply as an easier method of giving childbirth. Any procedure is going to have risks involved and this procedure is no different; however, if a woman is going to give birth to more than one child it seems to reason you would want to have a more conservative approach that would offer less chance of risk than have more complications so the next time she delivers will be a positive experience as well.

References

Banta, D. and Thacker, S. (1982). The risks and benefits of episiotomy: A review. Birth, 9(1), 25-30.

Bland, B. and Montgomery, T. (1939). Practical Obstetrics, 3^rd revised edition. Philadelphia: F.A. Davis Company.

Bodner-Adler, B., Bodner, K., Kaider, A., et al. (2001). Risk factors for third-degree perineal tears in vaginal delivery, with an analysis of episiotomy types. Journal of Reproductive Medicine, 46(8), 752-756.

Bodner-Adler, B., Bodner, K., Kimberger, O., et al. (2003). Management of the perineum during forceps delivery. Association of episiotomy with the frequency and severity of perineal trauma in women undergoing forceps delivery. Journal of Reproductive Medicine, 48(4), 239-242.

Center, R.-U.E.-b. (2005). The use of episiotomy in obstetrical care: A systematic review. U.S. Department of Health and Human Services.

Curtis, A. (1933). Obstetrics and Gynecology. Philadelphia: W.B. Saunders Co.

Combs, C., Robertson, P., and Laros, R. (1990). Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries. American Journal of Obstetrics and Gynecology, 163(1), 100-104.

Edwards, M. and Waldorf, M. (1984). Reclaiming birth: History and heroines of American Childbirth reform. The Crossing Press.

Leavitt, J. (1986). Brought to bed: Childbearing in America 1750 to 1950. New York: Oxford University Press, 179-186.

Riskin-Mashiah, S, O’Brian Smith, E., and Wilkins, I. (2002). Risk factors for severe perineal tear: Can we do better? American Journal of Perinatol, 19(5), 225-234.

Shiono, P., Klebanoff, M., and Carey, J. (1990). Midline episiotomies: More harm than good? Obstetrics and Gynecology, 75(5), 765-770.

Webb, D., Culhane, J. (2002). Hospital variation in episiotomy use and the risk of perineal trauma during childbirth. Birth, 29(2), 132-136.