Performed in one in five deliveries, episiotomy is a medical procedure often dreaded by women. A fear heard by the National College of French Gynecologists and Obstetricians (CNGOF) which, during its last congress, recommended reducing this practice, “useless in most births”.
Are the testimonies of women who have suffered gynecological and obstetrical violence about to finally be heard? While since 2014, many women want to publicize the abuse they have suffered during their gynecological and obstetrical follow-up, in particular via the hashtag #PayeTonUtérus or through testimonials compiled on blogs, the National College of French Gynecologists and Obstetricians (CNGOF) announced at the congress of the learned society which took place on December 6 in Strasbourg that the practices surrounding episiotomy had to change.
A strong physical and psychological impact
Experienced by many women as a trauma, the episiotomy consists of the incision on a few centimeters of the superficial muscles of the perineum to help the unborn child.
While the rate of episiotomies performed varies enormously depending on the maternity unit, many voices have been raised in recent years to denounce the excessive systematization of this medical procedure, performed during one in five deliveries according to the latest national perinatal survey published in 2017. According to another report, submitted to Marlène Schiappa in June 2018 by the High Council for Equality between Women and Men, one in two women on whom an episiotomy has been performed deplores a lack or total absence of explanations. on the pattern.
This is recognized today by the CNGOF, which states that this rate of episiotomies performed could be reduced. “We now know that this practice, which has a strong physical and psychological impact on women, will be useless in most births”, says in an article in the Figaro Professor Hervé Fernandez, head of the Bicêtre maternity unit (CHU Paris Sud), who did not participate in the development of the recommendations.
Moreover, the scientific literature on the subject of episiotomy is formal: in the event of normal and spontaneous delivery, and even if the child presents by the seat, the episiotomy does not offer any benefit in preventing a lesion of the perineum. This surgical procedure can also lead to increased pain and healing time compared to a simple perineal tear and complicate the resumption of sexual life after childbirth.
Episiotomy can be useful if instruments are used
In its recommendations, the CNGOF retains only one situation justifying recourse to episiotomy: when extraction instruments such as the suction cup or forceps are used during childbirth. “Instrumental extraction, especially with forceps, is associated with a risk of serious tearing that can extend to the anal sphincter. However, studies suggest, with however a low level of evidence, that episiotomy could have an action preventive”, explains Professor Xavier Fritel, gynecologist at the University Hospital of Poitiers and co-author of these recommendations.
But the practice of episiotomy in this situation should in no case become systematic. The CNGOF insists on the fact that the incision of the perineum is “to be considered” by the obstetrician, who must take into account risk factors such as a first delivery, the suspicion of a child of significant weight or the clinical condition of the perineum. “In certain circumstances, the obstetrician may be in favor of an episiotomy because he makes the woman take risks by using extraction instruments”, summarizes Professor Fritel.
Better inform women about the possibility of an episiotomy
The last recommendation of the CNGOF is to better inform women about the possible recourse to episiotomy in an emergency situation. This may indeed be necessary if there is a risk of tearing the perineum concerning the sphincter. This would affect 1 to 5% of births and can have serious consequences on the health of women. “To date, there is no risk prediction model for planning an episiotomy”, recalls Professor Fernandez. “She will always decide at the last moment in a certain urgency”. Hence the need to better inform women before giving birth and to take their expectations into consideration, in particular by making them formulate a birth plan, but also when entering the labor room, explaining to them why this gesture is considered.
.
