An episiotomy is a surgical incision made in the perineum - the area between the vaginal opening and the anus - during childbirth. It's performed to enlarge the vaginal opening to facilitate easier delivery.
Current guidelines recommend against routine episiotomies, favoring selective use only when medically necessary. Despite the known risks and side effects, episiotomies remain ideal in certain situations. Doctors should always provide counseling and proper post-procedure care instructions to their patients.
Still, doctors should also properly inform and get consent from their patients before doing this procedure. Even in emergency situations, verbal consent (if time allows for a brief explanation of this procedure’s goals and risks) is preferred over implied consent. Failing to fulfill any of these responsibilities mentioned above could potentially warrant a medical malpractice claim against negligent healthcare providers.
For expecting pregnant mothers, we suggest that you discuss your options and preferences with your doctor to avoid any adverse incidents during pregnancy.
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Understanding Episiotomy
The use of episiotomy in the US has dropped over the last century (from 63% in 1979 down to 12% in 2021). Still, the usage rate of this procedure varies from hospital to hospital; as low as <1% up to 40%. This suggests that some doctors prefer to do the procedure even when unnecessary.
While experts believe that episiotomy offers a better trajectory than natural tearing, various studies have since disputed this belief.
What of emergencies that deem this procedure necessary? In the following scenarios, doctors and midwives may opt to do the procedure [1] as a means to address any severe distress the mother or child may be experiencing; or [2] to mitigate any further injuries a mother may contract.
| 1. Large baby or Small pelvis - To prevent severe tearing in cases of cephalopelvic disproportion. 2. Instrumental Delivery - To create space for forceps or vacuum-assisted delivery. 3. Shoulder Dystocia - To enlarge the vaginal opening when the baby's shoulder is stuck. 4. Breech Presentation - To facilitate a smoother delivery in some breech cases. 5. Prolonged Second Stage - To expedite delivery when pushing has been ineffective. 6. Prevention of Severe Tearing - In some cases, a controlled incision may prevent more extensive, irregular tears. 7. Premature Birth - To reduce pressure on the baby's head during delivery. 8. Maternal Exhaustion - To shorten the pushing stage when the mother is extremely fatigued. 9. Previous Scarring - In cases where previous scarring might lead to more severe tearing. |
Any complications that may arise due to substandard execution of this procedure constitute medical malpractice. Doctors and midwives must use their best judgment to ensure that the laceration is necessary, minimal, and effective.
Can Episiotomy Cause Problems?
With proper anesthesia, mothers shouldn't feel pain during the procedure. They may still feel pressure or tugging sensations, of course. Pain is natural as the anesthetic wears off post-procedure.
Despite its potentially life-saving upsides, mothers who undergo this procedure are susceptible to complications and long-term side effects.
Short-term Complications
Pain, discomfort, and bleeding should be expected after an episiotomy. Apart from these physical woes, mothers are at risk of the following complications after the procedure:
- Infection
- Wound dehiscence (separation of the incision edges)
- Urinary retention (difficulty urinating due to pain or swelling)
- Perineal edema
- Difficulty with bowel movements (due to pain or fear of tearing)
- Temporary loss of perineal muscle strength
Long-Term Side Effects
Mothers (and their partners) may also take some time to reel from this procedure. Even after leaving the hospital, mothers who underwent this procedure would require special physical and emotional care. Some of the long-term side effects of this procedure include:
- Dyspareunia (painful sexual intercourse)
- Pelvic floor weakness
- Rectovaginal fistula (rare but life-threatening)
- Chronic perineal pain
- Altered sensation
- Pelvic organ prolapse
- Psychological stress
- Persistent urinary or fecal incontinence
- Sexual dysfunction (decreased libido or satisfaction)
- Scarring
Apart from these side effects, this procedure also increases the risk of episiotomy and perineal trauma in future deliveries. We emphasize that this procedure should be consented by mothers in most cases.
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How Can Episiotomy Be Avoided?
Several medical strategies could help mothers prepare for the delivery. While good nutrition and proper exercise is a good starting point, mothers can take extra measures to prepare themselves for delivery.
When looking to avoid episiotomy, your doctor may do/recommend the following:
| MEASURES | DESCRIPTION |
| Recommend perennial massages | Regular massage during late pregnancy increases tissue elasticity. |
| Recommend Kegel exercises | This strengthens pelvic floor muscles before and during pregnancy. |
| Patient counseling and education | Understanding the process can help mothers work with their bodies. |
| Warm compresses | Applied to the perineum during labor to increase flexibility |
| Upright or side-lying positions | These can reduce perineal pressure during delivery. |
| Skilled midwifery support | Hands-on techniques to support the perineum |
| Controlled pushing | Slow, guided pushing during delivery to allow gradual stretching |
| Avoiding unnecessary interventions | Induction or forceps when not medically necessary |
Speak to a Medical Malpractice Today
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If you or a loved one has been a victim of medical malpractice, please reach out to us for a non-obligatory free case evaluation. You can also contact us at 833-PORTER9 or info@porterlawteam.com to schedule a consultation.
