Episiotomies: History, Evidence and Current Practices

The Birth Link

For the last 60-80 years an incision in the vaginal opening to help the baby come up has been used routinely, with some experts stating, there is no reason not to, so don’t even worry about it!

Yeah.. that was Dr Diethelm specifically, in 1938. Speeding up the pushing stage, helping mom out after pushing for a long time, worrying about the baby being held inside by the tight perineum, trying to avoid major tears by giving a smaller incision, all in the hopes to help out.

Medical and surgical interventions became popular in the 1920s as deliveries moved to the hospital, of course! Most with the best intentions in mind. They thought of a great idea, to use this procedure on everyone and with the help of forceps, totally eliminating the mom from having to push at all! Thanks!

But has the actual evidence held up this theory? Well get into it today! Take what you’ve learned and start the conversation with your provider, remember knowledge is power! Stay informed and stay healthy!

In this episode of the Birth Link Podcast, Colette discusses the topic of episiotomies in detail to help you navigate episiotomies for an empowered birth experience.

00:00 Introduction and Personal Update

00:13 Exciting New Ventures in Maternal and Newborn Care

01:42 The Importance of Birth Plans and Privacy

02:02 Hospital Experiences and Challenges

04:30 Protecting Your Space During Labor

05:37 Introduction to Episiotomies

07:07 History and Evolution of Episiotomies

14:20 Medical Perspectives and Practices

21:29 Conflicting Evidence and Modern Views

23:02 Episiotomy Risks and Recovery

23:16 Hospital Guidelines and Doctor Preferences

23:56 Infection and Pain During Sex

24:30 Severe Perineal Trauma and Fourth Degree Tears

26:15 Shortening the Second Stage of Labor

29:45 Shoulder Dystocia and Episiotomy

31:10 Restrictive Episiotomy Policies

38:18 Factors Increasing Episiotomy Risk

40:02 Factors Lowering Episiotomy Risk

41:22 Importance of Discussing Episiotomy with Your Provider

44:46 Conclusion and Next Episode Preview

Resources:

• [Fetal expulsion: Which interventions for perineal prevention? CNGOF Perineal Prevention and Protection in Obstetrics Guidelines].
• Riethmuller D, Ramanah R, Mottet N.
• Gynecol Obstet Fertil Senol. 2018 Dec;46(12):937-947. doi: 10.1016/j.gofs.2018.10.029. Epub 2018 Oct 28.
• PMID: 30377094 French.

Mayo Clinic, Labor and delivery, postpartum care; Episiotomy: when it’s needed, when it’s not

Selective versus routine uses of episiotomy for vaginal birth

Hong Jiang 1, Xu Qian 1, Guillermo Carroli 2, Paul Garner 3

PMID: 28176333

PMCID: PMC5449575

DOI: 10.1002/14651858.CD000081.pub3

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