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Episiotomy

From: Melissa Bushy (melissa.bushy@und.nodak.edu)
Mon, 7 Oct 2002 10:53:10 -0500 (CDT)

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Hi, my name is Melissa, and I am a nursing student at the University of North Dakota. I have been interested in OB for a long time and hope to one-day work as a L&D nurse. Recently I have become interested in the necessity of episiotomy during the birthing process. I did some research and found out some interesting information. Research has shown that the most frequently performed surgery on women in the United States are episiotomies (Web, & Culhane, 2002). In the past (and possibly still in the present), some hospitals have had a protocol for performing routine episiotomies. As Olson, Olson, &, Cox stated, episiotomies are believed to be beneficial to both mother and fetus by “shortening the second stage of labor, lessening trauma to the baby, reducing the likelihood of a third-degree tear, reducing the likelihood of long-term pelvic relaxation, and reducing the likelihood of postpartum hemorrhage (p. 554,1990). However it has been shown that they actually increase the amount of blood loss, increase perineal infection rates, and increase trauma to the anal sphincter leading to possible fecal incontinence (Goldberg, Holtz, Hyslop, & Tolosa, 2002). Many studies have shown a variety of ways in which to decrease the incidence of episiotomies. One research article I read examined the relationship between birthing positions and episiotomies. It showed that the lateral or side-lying position was associated with the least amount of episiotomies performed, whereas the squatting position was associated with the most episiotomies performed. The other positions included in this study were; semi-recumbent, all fours, kneeling, and standing. It also showed a relationship between the medical professional attending the birth. Obstetricians were shown to have the highest incidence of episiotomies, whereas student midwives were shown to have the least (Shorten, Donsante, & Shorten, 2002). Another study looked at the benefits of perineal massage. This technique involved teaching the pregnant women the procedure for massage so they could perform it themselves throughout their third trimester of pregnancy. The procedure included using two to three fingers inserted in to the vagina up to three to four centimeters. Pressure is then applied and maintained downward on the vagina for two minutes, and to each side for two minutes. This technique increases elasticity in the perineum reducing the risk of tearing or the need for an episiotomy (Lebrecque, Eason, & Marcoux, et al., 1999). I am curious as to if any of these techniques or any others I have not mentioned, are used in practice. Also how often do you see episiotomies performed and does your hospital have a protocol for their use? Any information would be greatly appreciated. Thank you, Melissa Bushy, Student Nurse, University of North Dakota.

References Golberg, J., Holtz, D., Hyslop, T., &, Tolosa, J. (2002). Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000. Obstetrics and Gynecology, 99(3), 395-400.

Labrecque, M., Eason, E., &, Marcoux, S., et. al. (1999). Randomized control trial of prevention of perineal trauma by perineal massage during pregnancy. American Journal of Obstetrics and Gynecology, 180, 593-600.

Olson, R., Olson, C., &, Cox, N. (1990). Maternal birthing positions and perineal injury [Electronic version]. Journal of Family Practice, 30(5), 553-558. Retrieved September 26, 2002.

Shorten, A., Donsante, J., &, Shorten, B. (2002). Birth position, accoucher, and perineal outcomes: Informing women about choices for vaginal birth. Birth, 29(1), 18-27.

Webb, D., &, Culhane, J. (2002). Hospital variation in episiotomy use and the risk of perineal trauma during childbirth. Birth, 29(2), 132-136.

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