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No Episiotomy?!
Author(s) -
Thompson Derrick J.
Publication year - 1987
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1987.tb00924.x
Subject(s) - episiotomy , perineum , medicine , vagina , forceps , vaginal delivery , forceps delivery , obstetrics , surgery , pregnancy , genetics , biology
EDITORIAL COMMENT : Episiotomy is an important and common operation. Some practitioners perform the procedure almost as a routine, others avoid it almost at any price and claim that the operation is seldom necessary. The advocates of episiotomy claim that its performance when the head k safe& accessible must, by hastening delivery, avoid hypoxia that can cause perinatal death or intellectual impairment. Other considerations are maternal discomfort (painful perineum, subsequent dyspareunia) and the possibility that overstretching of the perineum to avoid episiotomy may predispose to prolapse. This paper re‐examines the mechanism of delivery of the head and advocates maintenance of flexion to avoid a perineal tear — it concentrates on pressure on the occiput and anterior vagina thus directing pressure away from the perineum. The method warrants consideration. Summary: A method is presented which with careful manipulation of the vagina around the crowning head reduces the incidence of an episiotomy or a perineal tear. Using the method described, the overall result obtained was an intact perineum in 68% of vaginal deliveries (which included forceps deliveries). An episiotomy was performed in only 7% of deliveries — all associated with the use of forceps.