March 15, 2002 – The practice of episiotomy (surgical incision of the perineum) continues to decline in the United States, according to a study in a hospital in Philadelphia and published in the journal Obstetrics & Gynecology.1
The percentage of women having had an episiotomy during a natural delivery dropped from 70% in 1983 to 19% in 2000 in this hospital without a special policy having been applied to this hospital. about. The data differ slightly in Quebec with a drop from 72.2% in 1982/1983, to 31.8% in 1999/2000.2
Episiotomy spread in the 1940s when childbirths became medicalized and transferred to hospital. It reached its peak in the 1970s when it was practiced in the majority of women giving birth in hospital. Then the controversy over its systematic use arose in the 1980s as a result of studies; its use was then restricted.
In North America, the midline episiotomy (between the vagina and the anus) is preferred, while in Europe, the medio-lateral episiotomy is preferred (on the right side for right-handed people and left for left-handed people). Advocates of systematic episiotomy generally cite the risk of perineal tears, especially during a first birth, as well as the risk of prolapse (descent of organs), urinary or anal incontinence and dyspareunia (pain during pregnancy). sex). Critics say it causes more severe tears (three times as many)3 which can lead to fecal incontinence, vagino-anal fistulas and urinary incontinence. Studies abound in this direction. However, its practice is not called into question in specific cases, when the baby is in danger for example.
Doctors recommend a good preparation of the perineum during pregnancy by exercises and massages. The position during childbirth as well as the way of pushing would also play an important role in the tension of the perineum. After an episiotomy, perineal rehabilitation is usually recommended; we can add complementary treatments such as homeopathy or aromatherapy which especially help to heal.4
Élisabeth Mercader – PasseportSanté.net
According to InteliHealth, February 26, 2002
1. Goldberg J, Holtz D, Hyslop T, Tolosa JE. Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000. Obstet Gynecol 2002 Mar; 99 (3): 395-400.
2. Quebec Health and Social Services. Evolution of some obstetric interventions during vaginal childbirth, Quebec 1982-1983 to 1999-2000. [Consulté le 13 mars 2002]. http://www.msss.gouv.qc.ca/f/statistiques/index.htm
3. Laval University. The midline episiotomy would triple the risk of serious tears of the perineum. [Consulté le 13 mars 2002]. http://www.ulaval.ca/scom/Communiques.de.presse/1994/05/001.html
4. GyneWeb. The Postpartum Guide. The consequences of the episiotomy. [Consulté le 13 mars 2002]. http://www.gyneweb.fr/Sources/gdpublic/post-partum/episio.htm
