Wednesday, December 15, 2010

The Unkindest Cut

Episiotomy is a surgical incision made at the time of birth to enlarge the vaginal opening.  It was a rarely used procedure restricted mainly to complicated deliveries until 1915 when it was made popular by two prominent obstetricians, Pomeroy and DeLee. De Lee had developed a delivery technique which involved cutting a large episiotomy and delivering the baby with forceps as soon as a woman was found to be fully dilated.  He theorised that his technique prevented tears that could lead to incontinence or a sagging pelvic floor( those muscles which criss-cross between the vagina and anus and keep everything in place).  Without evidence or research the theory was taken as fact and soon became standard practice in many hospitals with most obstetricians incorporating episiotomy into their normal delivery routine. It wasn't until 1983 that the first major study of episiotomy was undertaken. Its conclusion?  Episiotomy disastrously weakens the perineum making it far more likely for a woman to sustain a serious perineal tear ( known as a third degree tear ).

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