Towards the end of pregnancy, the vulva becomes swollen and tender, and due to this change, the area around the vaginal opening expands well during labor to allow the baby to pass. However, first-time mothers do not dilate well and give birth quickly, and the fetus comes out before it is fully expanded. This is where the tear occurs from the vagina to the perineum. In order not to tear the perineum, the doctor controlled the fetus with his hands. Waiting for the vaginal opening to expand is called perineal protection. However, in order not to prolong labor, the perineum should be incised before tearing occurs.
Cuts heal more quickly than lacerations, and one of the reasons to aggressively perform an episiotomy is to clean the wound.
Incision surgery involves performing pudendal nerve anesthesia or subcutaneous infiltration anesthesia around the vaginal opening, and then making an incision about 3cm from the vagina to the perineum. The incision is closed after delivery.
Benefits of episiotomy:
1. Reduce late perineal injury, suture and healing complications that occur within 7 days after delivery.
2. Prevent perineal tears and protect pelvic floor muscles. It is believed that surgical incisions are easy to repair and heal better.
The following points should be noted during episiotomy:
The limited use of side incisions does not lead to further adverse consequences such as vaginal or perineal injury, pain, dyspareunia, or urinary incontinence. The only disadvantage is an increased risk of preperineal tears.
For some mothers who can give birth smoothly without side incision, it will increase unnecessary pain. Moreover, side injuries may heal quickly physically, but the psychological impact on some mothers is lingering.
As a routine operation for natural delivery, episiotomy has a limited scope of application, but it accounts for about 90% of vaginal deliveries in my country and about 20% abroad.
Why is episiotomy so widely used in China? Is there a risk of perineal tearing without a side incision? Objectively speaking, side incision should not be used as a routine clinical operation, but there are many prerequisites for accurately judging whether pregnant women need side incision. A very important point is that today\’s obstetricians and nurses have a strong sense of responsibility and superb medical skills. Rich clinical experience and judgment ability, as well as more meticulous care and care for pregnant women. However, the current medical level and diagnosis and treatment environment in most areas of our country cannot meet these conditions. It is premature to perform limited transverse incisions. If we blindly reduce the rate of side incisions, it will do more harm than good, such as increasing cases of perineal tears and even threatening the health and life of the fetus.