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Definition of Episiotomy and Definition
Episiotomy is a surgical incision through the tissues of the perineum to extend the opening of the vaginaduring childbirth. The most common types of episiotomy are the midline (median) incision, which extends from the vaginal opening toward the anus, and the mediolateral incision, which extends from the vaginal opening diagonally to either side.
The obstetrician numbs the tissues of the perineum with an injected local anesthetic (if the woman does not already have epidural anesthesia), then makes the incision. After delivery of the baby and the placenta, the obstetrician sutures (stitches) the incision closed.
Though once commonplace as a routine measure to prevent tearing of the vagina and surrounding tissues, episiotomy is now a procedure most obstetricians perform only when it appears that a natural tear will penetrate into the muscles of the perineum or rectum.
The prevailing belief supporting preventive episiotomy had been that the clean cut of a surgical incision healed more rapidly and with fewer complications than the often jagged wound that occurred with a natural tear (also called a laceration). However, numerous studies have failed to support this premise, and the American College of Obstetricians and Gynecologists (ACOG) now advises against routine episiotomy.
Most episiotomies heal in four to six weeks though some women experience discomfort or pain for up to several months, especially with sexual intercourse. Typically the obstetrician uses sutures the body absorbs as the incision heals.
Risks of episiotomy include excessive bleeding, infection, and weakening of the muscles of the pelvic floor that may result in urinary incontinence, fecal incontinence, and painful sexual intercourse.
Many practitioners who provide care for women during pregnancy and childbirth advocate prenatal efforts, such as perineal massage to increase tissue elasticity and kegel exercises to strengthen and tone the pelvic muscles; perineal massage during labor may also reduce the risk for natural tears and thus lower the likelihood for episiotomy.
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