What is Episiotomy? Will I need one
and what is the evidence for Episiotomy?

Episiotomy is the medical procedure where an incision is made between the vagina and the perineum to assist with the birth of the baby or to prevent the perineum tearing.

There is a lot of contention around the need for episiotomy and you should certainly voice your concerns to your care team and in your birth plan if you wish to avoid it. We have provided a brief abstract of a clinical study below, looking at the outcomes of episiotomy. Remember to discuss it well in advance with your midwife and make your own mind up about it.

There are instructions on perineal massage on our downloads page, which should be undertaken daily from 6 weeks before term. This will help to condition the tissues around the vagina and perineum but it must be performed daily along with kegel (pelvic floor) exercises. Your midwife will explain how to perform these, but essentially they involve clenching and unclenching the muscles that you would use to stem the flow of urine, and squatting and streching exercises of the pelvis. We discuss these excercises and give clear instructions on how to perform perineal massage on our CD programme.

References.

Reproduced from Obstetric Myths verses Research reality by Henci Goer:

"Like any surgical procedure, episiotomy carries a number of risks: excessive blood loss, haematoma formation, and infection. . . . There is no evidence . . . that routine episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents foetal trauma or reduces the risk of urinary stress incontinence." Sleep, Roberts, and Chalmers 1989

Relationship of Episiotomy to Perineal Trauma and Morbidity, Sexual Dysfunction, and Pelvic Floor Relaxation

Klein MC, MD; Gauthier RJ, MD; Robbins JM, PhD; Kaczorowski J, MA; Jorgensen SH, MB; Franco ED, MD; Johnson B, BSN; Waghorn K, RN; Gelfand MM, MD; Guralnick MS, MD; Luskey GW, MD; Joshi AK, MD, Am J Obstet Gynecol. 1994;171:591-598

Purpose of Study: To compare status 3 and 6 months postpartum in women receiving vs those not receiving median episiotomy, using as outcomes perineal pain, urinary and pelvic floor functioning, and sexual functioning, and to analyze the relationship between episiotomy and third- and fourth-degree tears.

Conclusion: The results of the first North American randomized controlled trial indicate that the routine use of episiotomy has no justification. Median episiotomy fails to prevent trauma or relaxation of the pelvic floor; furthermore, in primiparous women it appears to be causally associated with third- and fourth-degree tears. This procedure should be limited to specific maternal and fetal indications.

You can make your own minds up as to whether you are willing to accept suggestions of episiotomy but the clinical studies that we have reviewed do not support the routine use of episiotomy. As with any physical activity, preparation is the key. We would recommend yoga and regular perineal massage as the best methods of pre-conditioning your pelvic floor prior to birth.