Episiotomy: understand its risks and the importance of a humanized delivery

Many questions arise during pregnancy, including those related to childbirth. With that in mind, we talked to gynecologist and obstetrician Patrícia Germanovix do Carmo (CRM PR 21605 | RQE 16603), who told us all about episiotomy to let you know. Check out!

What is episiotomy?

Episiotomy is an incision (cut) made in the region of the perineum, which is the muscle between the vagina and anus, to enlarge the birth canal. Patrícia says that, until recently, it was taught as a necessary routine in obstetric practice to prevent the perineum from tearing and thereby injuring the anus and rectum (final part of the intestine).

Currently, it should not be practiced in this indiscriminate way. But the real indications are also not clear, and some can be considered, such as the need for instrumental delivery (forceps or vacuum extractor), fetal distress, access to flex the baby’s head, fetal macrosomia (very large baby and the shoulders do not pass) , breech presentation (baby sitting). Patrícia also points out that it should always be performed with anesthesia (local or spinal).

Risks and consequences of episiotomy

“The truth is that a big cut was made to avoid a laceration that might not even happen or that would be, in the absolute majority of the times, small”, says the doctor.

Therefore, we must pay attention to the consequences of the procedure, in order not to subject the mother to unnecessary risk. Patrícia points out that scarring can cause “fibrosis”, which leaves the region hardened and with little elasticity, causing local pain and pain during sexual intercourse, impairing the woman’s quality of life. In addition, it increases bleeding and the risk of infection.

More episiotomy questions answered

1. What are the types of episiotomy? It is usually performed “medio-laterally”, meaning it is from the middle of the perineum to the right side, directing the cut away from the anus. But it can also be “median”, right in the middle of the perineum.
2. How many stitches are given in episiotomy? The number of stitches to make the episiorrhaphy (closing) of the incision will depend on the size in extension and depth.
3. What is the difference between episiotomy and episiorrhaphy? Episiorrhaphy is the suturing (closing) of the cut made in the episiotomy. This suture is made in layers from the inside out, respecting the tissues.
4. What is the difference between laceration and episiotomy? Laceration is the injury caused naturally when the baby comes out, classified according to its location (periurethral, ​​vaginal or perineal wall) and depth in the perineum, being grade 1 when it involves only the mucosa, grade 2 when it reaches the outermost muscle layer. , grade 3 affects the innermost and grade 4 damages the anus/rectum. Patrícia says that many studies show that in the absolute majority of cases up to grade 2 lacerations occur, the deeper ones being very infrequent, so it was concluded that episiotomy is not absolutely necessary.
5. Is episiotomy a crime? The practice of selective episiotomy is not a crime. The World Health Organization (WHO) considers it acceptable that it is performed in up to 10% of assisted births, this shows that the practice is not absolute and that there is criteria in its performance.

According to the gynecologist and obstetrician, the most important thing is that the woman is informed about any procedure that is deemed necessary during her care. Having a good bond with the team that assists them is a fundamental part of humanization, which facilitates understanding and improves care.

Experiences with episiotomy

We selected videos that address information about episiotomy, in addition to the experience of women who underwent the procedure. Release play and inform yourself.

Is episiotomy necessary?

Eleonora Moraes is a psychologist and doula, and went through the episiotomy process. She tells us how it is done, if it is necessary and how it was her experience, with images that explain the anatomy of the female body. Worth checking out!

About obstetric violence

Bela Gil tells us about what characterizes obstetric violence, citing examples and what our rights are. In addition, she tells us about her experience with episiotomy. Was she interested? Click on the video and learn more.

How to deal with a postpartum complication

Unfortunately, some women go through an episiotomy and a tear, or even both problems together. This is the case of Fefa, who told us about her healing and gave tips to help other moms in this process. Follow up!

Information is the best weapon we can use to protect ourselves from situations like episiotomy. So know your rights and fight for them! Learn all about the puerperium for a better experience with motherhood!