How does episiotomy work?

Is the episiotomy systematic?

For years, episiotomy was commonplace, especially at the first childbirth (more than one mother

On two !). Studies have shown that when practiced systematically, it brought no benefit to both mother and baby. Since 2005 and the recommendations of the National College of French Gynecologists and Obstetricians, the teams have improved their practices and the rate has increased to 20%.

This intervention was supposed to prevent the risk of tearing and prevent urinary incontinence or prolapse (organ descent). Several studies have subsequently shown the opposite. An episiotomy would actually be more risky than a maternal tear, because the incision is often larger, requires sutures, causes more bleeding and heals less quickly. In 2005, the College of French Gynecologists published recommendations to limit this practice. The medical team should only perform an episiotomy when they deem it really necessary. These recommendations were heard since according to the latest survey by Ciane, a group of user associations, the rate of episiotomies decreased in 2013. It stands at 30%.

Is the episiotomy painful?

The episiotomy, an incision made in the perineum to facilitate the exit of the baby, is feared by many mothers.

Usually, the incision hardly hurts. First of all because, under epidural, all the pain is lessened. In addition, because the practitioner usually incises during a contraction, which captures your full attention. The suture is more painful. But it is generally the subject of a local anesthesia with xylocaine, or locoregional, carried out at the same time as the epidural. It is during the first few days, and sometimes the first weeks, that the episiotomy is most troublesome.

Is episiotomy mandatory for a first baby?

Not necessarily. According to the 2016 perinatal survey, the episiotomy rate is 34,9% for a first delivery, 9,8% for the following. An episiotomy can be done when the baby is heavier than average or if their head is too large, their heart rate is slowing and their exit needs to be speeded up. This intervention is also considered if the baby is in breech for example or if the mother’s perineum is fragile.

To discover in video: How to avoid episiotomy?

In video: How to avoid episiotomy?

How long does it take for an episiotomy to heal?

Very quickly – about 8 to 10 days – for the skin, the visible part of the episiotomy. It is longer inside where it takes between 12 and 18 months for everything to be well healed … Hence discomfort, even a painful sensation which can sometimes last several months after childbirth. In the first few days, you may have difficulty sitting down and moving. Tell the medical team. She will give you an anti-inflammatory treatment to relieve you. Isabelle Hallot

Can we refuse an episiotomy?

No medical act or treatment can be performed without the free and informed consent of the person. Thereby, you can refuse to have an episiotomy. It is important that you discuss this with your gynecologist or midwife. You can also mention your refusal of the episiotomy in your birth plan. However, on the day of delivery, if the team judges that the episiotomy is essential, you will not be able to oppose it.

Does the epidural affect the episiotomy?

The two are not related. A woman who is on an epidural will not necessarily have an episiotomy. Nevertheless, it is certain that the epidural, insofar as it numbs the perineal area, can lead to misdirected thrusts which stretch the perineum too much. Therefore, episiotomy may be necessary.

How to avoid episiotomy?

To soften the perineum and make it a little more stretchy on D-Day, “you can massage it a few weeks before childbirth with vegetable oil for about ten minutes. This intimate massage would slightly reduce the risk of having an episiotomy *. However, this requires being comfortable with your body, which is not given to all expectant mothers, ”says Professor Deruelle. (IH)

With Prof. Philippe Deruelle, obstetrician, secretary of the College of French gynecologists and obstetricians.

* 2016 perinatal survey figure

 

 

 

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