An Episiotomy (pronounced ee-peas-ee-ott-om-ee) is the surgical cut given by the caregiver into the perineal tissue that separates the woman's lower vagina from her anus, usually during the
crowning phase of a vaginal birth. In Australia it is usually done with scissors (after an injection of local anaesthetic if an epidural is not in place), but can be performed with a scalpel or surgical blade.
There are 2 types of episiotomies, a midline (or median) episiotomy and a mediolateral episiotomy. A midline episiotomy involves the cut going down in a straight line towards the woman's anus. A mediolateral episiotomy involves the cut being done at about a 45 degree angle to one side of the anus.
The cut can range from 3 to 7 centimetres (average 5 cms) and is regarded as equivalent to a
2nd degree tear of the perineum. The cut divides some of the pelvic floor muscles and needs to be repaired with stitches (and possibly more local anaesthetic) after the baby is born.
Image 7-22 shows a drawing of where a mediolateral episiotomy is performed, with the dark line indicating where a midline episiotomy would be performed.
History of episiotomy
The first episiotomy was reported in 1741, being suggested as a way to prevent severe perineal tears...a contradiction in terms? The centuries that followed saw it only being used on occasions, usually by male birth attendants. The worldwide rate of episiotomy increased dramatically in the early 1900's, coinciding with the move from women giving birth at home to having their baby in a hospital. This is when physicians became more involved in the normal, uncomplicated birth process.
The growing popularity of episiotomy saw it become one of the most common surgical procedures performed, but became widely used well before any research was conducted to assess its' effectiveness.