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Re: Mediolateral episiotomyFrom: DoctorJoe@aol.comTue Sep 2 11:21:07 2003
In a message dated 9/2/03 09:59:56, RModugno@aol.com writes:
> > More pain, more dyspareunia. OK... so let's sit back and take stock of what we're thinking. 1) Mediolateral episiotomies are worse than midlines. We all agree. Some programs forbid MLs totally. 2) Midline episiotomies often extend into the rectum. This is bad and can lead to fecal incontinence, yada, yada, yada. 3) NO episiotomy is better - but you have to wait until the last minute to determine if you need one or not. At THAT point, however, you may have damaging stretching of the pelvic floor, leading to SUI and etc. in the future (making for more work for the urogyne people, but that's not what we want really). 4) Elective c-section avoids 1, 2, and 3. So, we can all feel comfortable that a new standard of care should be the old perinatologists' maxim - Section them all unless you have a good reason not to. How's that? Joe P.
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