doi: 10.56294/nds2024110

 

Short communication

 

Episiotomy: from common practice to selective intervention

 

La episiotomía: de práctica común a intervención selectiva

 

Agustina Campo1 *

 

1Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Medicina. Buenos Aires, Argentina.

 

Cite as: Campo A. Episiotomy: from common practice to selective intervention. Nursing Depths Series. 2024; 3:110. https://doi.org/10.56294/nds2024110

 

Submitted: 24-06-2023                   Revised: 23-09-2023                   Accepted: 05-01-2024                 Published: 06-01-2024

 

Editor: Dra. Mileydis Cruz Quevedo

 

Corresponding author: Agustina Campo *

 

ABSTRACT

 

Episiotomy was a surgical incision made in the perineum during childbirth to facilitate the delivery of the baby and prevent severe tearing. Although traditionally used routinely, its use was questioned due to a lack of evidence of its benefits and the complications it could cause. Studies showed that it caused more pain and slower recovery than natural tearing. Complications included bleeding, infection, pain during sexual intercourse and, in severe cases, fistulas. The WHO advised against its routine use and promoted its use only in justified cases. In Argentina, although it was common, more restrictive policies were adopted, which showed better results for women.

 

Keywords: Episiotomy; Childbirth; Complications; Tears; Recovery.

 

RESUMEN

 

La episiotomía fue una incisión quirúrgica practicada en el periné durante el parto con el fin de facilitar la salida del bebé y prevenir desgarros graves. Aunque tradicionalmente se utilizó de forma rutinaria, su aplicación fue cuestionada por la falta de evidencia sobre sus beneficios y por las complicaciones que podía ocasionar. Estudios demostraron que generaba más dolor y una recuperación más lenta que los desgarros naturales. Las complicaciones incluyeron hemorragias, infecciones, dolor durante las relaciones sexuales y, en casos graves, fístulas. La OMS desaconsejó su uso sistemático y promovió su empleo solo en casos justificados. En Argentina, aunque fue común, se adoptaron políticas más restrictivas que demostraron mejores resultados para las mujeres.

 

Palabras clave: Episiotomía; Parto; Complicaciones; Desgarros; Recuperación.

 

 

 

BACKGROUND

Episiotomy is a surgical incision in the perineum made during childbirth to widen the birth canal and facilitate the delivery of the baby.(1) Traditionally, it has been used to prevent severe perineal tears and to speed up labor.(2) However, its routine use has been questioned due to its potential complications and the lack of evidence to support its benefits in all cases.(3)

Studies have shown that episiotomy can cause more pain than a natural tear, both at the time of delivery and in the days following. In addition, recovery may be longer and more complicated in cases of episiotomy.(4,5)

Complications associated with episiotomy include hemorrhage, infection, dehiscence (separation of the wound), hematoma, and edema. In the long term, it can lead to pain during sexual intercourse (dyspareunia), painful scar formation, and, in severe cases, rectovaginal fistulae.(6)

On the other hand, vaginal tears, which occur naturally during childbirth, are classified according to their severity.(7) First- and second-degree tears usually heal without significant complications. In contrast, third and fourth-degree tears may require surgical intervention and have a higher risk of complications such as fecal incontinence.(8,9)

The World Health Organisation (WHO) advises against the routine use of episiotomy and recommends its use only in specific cases where it is medically indicated.(10) Selective use of episiotomy is associated with a reduction in subsequent perineal trauma and fewer healing complications.(11)

In Argentina, many hospitals routinely perform episiotomies, although policies are shifting towards more restrictive use.(3) Local studies have shown that selective episiotomy reduces complications without increasing risks to the mother or baby.(12)

Current evidence suggests that episiotomy offers no significant benefits over natural tears in most cases and may be associated with increased complications. Therefore, its use should be carefully evaluated and reserved for situations where it is clearly indicated. Promoting evidence-based, woman-centered practices is essential to improving birth outcomes and mothers’ experiences.

 

BIBLIOGRAPHICAL REFERENCES

1. Hartinah A, Usman AN, Sartini, et al. Care for perineal tears in vaginal delivery: an update for midwife. Gac Sanit. 2021;35(Suppl 2):S216–20. Disponible en: https://doi.org/10.1016/j.gaceta.2021.10.024

 

2. Aguiar BM, Silva TPRD, Pereira SL, et al. Factors associated with the performance of episiotomy. Rev Bras Enferm. 2020;73(suppl 4):e20190899. Disponible en: https://doi.org/10.1590/0034-7167-2019-0899

 

3. Bączek G, Rychlewicz S, Sys D, Rzońca P, Teliga-Czajkowska J. Episiotomy for medical indications during vaginal birth—retrospective analysis of risk factors determining the performance of this procedure. J Clin Med. 2022;11(15):4334. Disponible en: https://doi.org/10.3390/jcm11154334

 

4. He S, Jiang H, Qian X, Garner P. Women’s experience of episiotomy: a qualitative study from China. BMJ Open. 2020;10(7):e033354. Disponible en: https://doi.org/10.1136/bmjopen-2019-033354

 

5. Klein MC, Kaczorowski J. Routine use of episiotomy with forceps should not be encouraged. CMAJ. 2020;192(8):E190. Disponible en: https://doi.org/10.1503/cmaj.74132

 

6. Zhang D, Bo K, Montejo R, et al. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: systematic review and meta-analysis of randomized clinical trials. Acta Obstet Gynecol Scand. 2024;103(6):1015–27. Disponible en: https://doi.org/10.1111/aogs.14744

 

7. MacLellan J, Webb SS, Byrne C, et al. Informed consent in episiotomy: co-analysis with midwives and distillation of best practice. Birth. 2023;50(4):773–80. Disponible en: https://doi.org/10.1111/birt.12721

 

8. Radnia N, Khansari S, Jiriaei N, Hosseini SA, Salemi L, Hamoon M. The relationship between perineal size and episiotomy during delivery. J Med Life. 2022;15(11):1379–83. Disponible en: https://doi.org/10.25122/jml-2021-0390

 

9. Sultan AH, de Leeuw JW. Episiotomy and operative vaginal delivery: do we need more evidence? BJOG. 2021;128(10):1672–3. Disponible en: https://doi.org/10.1111/1471-0528.16783

 

10. Koh LM, van Roon Y, Pradhan A, Pathak S. Impact of the EPISCISSORS-60 mediolateral episiotomy scissors on obstetric anal sphincter injuries: a 2-year data review in the United Kingdom. Int Urogynecol J. 2020;31(9):1729–34. Disponible en: https://doi.org/10.1007/s00192-019-04201-7

 

11. Tantengco OAG, Velayo CL. Episiotomy practice and perineal trauma in the Philippines. Lancet Reg Health West Pac. 2022;19:100381. Disponible en: https://doi.org/10.1016/j.lanwpc.2022.100381

 

12. Alexander JW, Karantanis E, Turner RM, Faasse K, Watt C. Patient attitude and acceptance towards episiotomy during pregnancy before and after information provision: a questionnaire. Int Urogynecol J. 2020;31(3):521–8. Disponible en: https://doi.org/10.1007/s00192-019-04003-x  

 

FINANCING

None.

 

CONFLICT OF INTEREST

None.

 

AUTHORSHIP CONTRIBUTION

Conceptualisation: Agustina Campo.

Data curation: Agustina Campo.

Formal analysis: Agustina Campo.

Research: Agustina Campo.

Methodology: Agustina Campo.

Project management: Agustina Campo.

Resources: Agustina Campo.

Software: Agustina Campo.

Supervision: Agustina Campo.

Validation: Agustina Campo.

Visualisation: Agustina Campo.

Writing - original draft: Agustina Campo.

Writing - proofreading and editing: Agustina Campo.