Introduction
An episiotomy is the most common obstetrical procedure of all. Its purpose is to widen the entrance to the vagina by cutting into the perineum (the region between the vagina and the anus). This is intended to make it easier for the baby to pass through and to relieve the mother’s pelvic floor.
In this respect, an episiotomy is therefore usually the “lesser of two evils” compared to a possible uncontrolled perineal tear. The gynaecologist can either make the decision for an episiotomy before birth, for example in the case of a multiple pregnancy or certain position variants (see below). This is then called an early episiotomy.
On the other hand, a so-called early episiotomy can also be performed during birth, for example in the case of an unexpectedly large child or if the doctor notices that the mother’s pelvic floor is in danger of tearing. There are different types of episiotomy depending on the type of incision. The most frequent type of incision is the mediolateral one, which starts in the middle of the perineum and cuts at a 45° angle to the side. This incision creates a relatively large amount of space, can be widened during birth if necessary, and involves a relatively low risk of intestinal injuries. While a median incision (from the perineum vertically downwards) creates relatively little space but heals best, the lateral incision (from the side of the perineum outwards) is only used for particularly difficult births, as it can create the most space but also involves the most difficult healing process.
Causes of an episiotomy
Among the causes that can lead the gynaecologist to consider an episiotomy are, first of all, purely mechanical aspects. For example, a large circumference of the child’s head and a narrow diameter of the mother’s pelvis increase the risk of the need for an episiotomy. In addition, some special positions of the child also require an episiotomy, especially the pelvic floor.
In this position, the child’s pelvis, rather than its head, is the first to go. On the basis of other aspects (weight of the child, pelvic measurements, gestational age, etc.) it is decided whether the child should be born by caesarean section or naturally.
In the latter case, an episiotomy is often necessary to ensure that the child has enough room to pass through. In addition, an episiotomy is also often necessary for the natural birth of multiple babies. In addition, premature birth is usually an occasion for an episiotomy, as the mother’s pelvic floor is not yet sufficiently prepared for the birth.
Even if the mother has already had an episiotomy during one birth, there is often a need for a new episiotomy at a subsequent birth. This is due to the possible hardening and tightening of tissue in the area of the perineal scar, which can complicate the birth of the second child. A particularly urgent reason for an episiotomy can occur if complications arise during birth. If the gynaecologist notices, for example, a drop in the child’s heartbeat, he can perform an episiotomy to speed up the birth and thus save the child.
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