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Concept
Episiotomy
Summary
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. This is usually performed during second stage of labor to quickly enlarge the aperture allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left (medio-lateral episiotomy), is performed under local anesthetic (pudendal anesthesia), and is sutured after delivery.
Its routine use is no longer recommended, as perineal massage, a form of the plastic surgeon's principle of 'skin tissue expansion' applied to the vaginal cavity, is an alternative painless method of enlarging the orifice for the baby. It is nonetheless one of the most common surgical procedures specific to 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 Korea, Japan, Taiwan, China, and Spain.
Vaginal tears can occur during childbirth, most often at the introitus as the baby's head passes through, especially if the baby descends quickly. Episiotomies are used in an effort to prevent soft-tissue tearing (perineal tear) which may involve the anal sphincter and rectum. 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 injuries 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 are 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.
Official source
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