What is an episiotomy?
Episiotomy is a procedure that involves cutting an average of 2.5 to 6 cm into the lower vagina and perineum muscles (a group of muscles and ligaments between the anus and vagina that support the pelvic organs) during childbirth. The aim is to widen the vaginal orifice, making it easier and quicker for the baby to come out, and to avoid serious spontaneous tearing by preferring a clean cut, as well as organ descent and stress incontinence.
The incision is often made diagonally, but can also be lateral (to avoid anal tears) or vertical.
Once the delivery is complete, the incision is closed with absorbable sutures. This suture is also necessary if a natural tear occurs.
However, this procedure has a number of disadvantages, such as possible pain lasting several days or even weeks, swelling at the incision site, risk of infection, significant blood loss, increased risk of deep perineal tear, or persistent pain during intercourse. In addition, after childbirth and until the scar closes, it must be rinsed and dried after each trip to the toilet.
Simple measures can therefore be put in place to reduce the risk of perineal tearing, such as pushing in a side-lying position, applying a warm compress to the perineum, applying pressure to the perineum to support it during pushing, as well as massaging the perineum.
Find out more from our health professionals about how to prepare your perineum for childbirth and avoid an episiotomy:
Is episiotomy less common?
Episiotomy was introduced 250 years ago, and was performed almost systematically, particularly for first-time pregnancies. In the early 1990s, it accounted for over 50% of deliveries in France, and even 80% in the 1980s.
Today, it's being called into question, and less and less practiced, in line with the recommendations set out by the Collège national des gynécologues et obstétriciens français in 2005, which stipulates that episiotomy should only be performed in cases where it's necessary, and should not concern more than 30% of deliveries.
In the 1980s, women's organizations in the USA and Canada called for a precise evaluation of episiotomy. The study, which appeared in 1984, showed that systematic episiotomy was of no benefit to either baby or mother. Further studies confirmed the facts, showing that a restrictive episiotomy practice resulted in an increased number of intact perineas, without an increase in severe tears.
In the 90s, the WHO recommended that countries should not perform more than 20% episiotomies during childbirth, and subsequently reduced this percentage to 10%, as is the case in Sweden, while France still has a rate of around 30%.
Episiotomy can be performed for the birth of large babies (over 4 kg), breech babies, when forceps need to be used, in obstetric emergencies, or if the mother's perineum is short and there is a threat of serious tearing.
Moreover, episiotomy must be performed with the pregnant woman's consent. We therefore advise you to discuss the circumstances under which an episiotomy may be performed with your doctor prior to delivery.
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