Previously it was thought that episiotomies prevented the risk of perineal tears during childbirth. Now it is largely agreed that the reverse is true, with the risk being especially prevalent if a midline episiotomy is carried out.
Why is an episiotomy needed?
Episiotomies are not carried out routinely, although they were very common in the past. Now they are only performed if there is a clinical need. This will include, for example, if the baby is showing signs of distress and the birth needs to be sped up. Another common reason is that an assisted delivery is about to be carried out and the vagina needs to be widened.
How is an episiotomy performed?
An episiotomy can be done by either a midwife or a doctor. Adequate pain relief should be put in place, after which a sharp pair of scissors will be used to cut the perineum – the area of skin between the vaginal opening and the anus. The cut will be made from the back of the vagina, diagonally downwards.
When the cut is made diagonally it is called a medio-lateral episiotomy. This is opposed to a midline episiotomy, whereby the cut is made straight downwards. Midline episiotomies should no longer be practiced in the UK as they increase the risk of perineal tears.
Do episiotomies prevent tears?
An episiotomy does not prevent a perineal tear. As described above, a midline episiotomy can increase the risk of a tear.
Nevertheless, this knowledge has only come to light relatively recently. Previously it was thought that an episiotomy reduced the risk of a tear occurring. As such episiotomies would be performed almost as matter of routine. This was opposed by various experts and consumer groups, and now episiotomies are only carried out when there is a clinical need to do so.
Occasionally an episiotomy will lead to a medical negligence compensation claim. Normally this will arise if:-
- The episiotomy is poorly performed – e.g. blunt scissors are used, or a midline episiotomy is carried out;
- The episiotomy is poorly repaired;
- The episiotomy leads to a third or fourth degree tear which is not diagnosed and repaired;
- An episiotomy was carried out when there was no clinical need to do so.
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