Episiotomy for vaginal birth

Limiting the use of episiotomy to strict indications has a number of benefits: less posterior perineal trauma, less need for suturing and fewer complications. Episiotomy does not lead to reduction in most pain measures and severe vaginal or perineal trauma, although it may increase the risk of anterior perineal trauma.

RHL Commentary by Jerker Liljestrand

EVIDENCE SUMMARY

Restrictive use of episiotomy in uncomplicated vaginal births, as compared with routine episiotomy, is associated with reduced risk of posterior perineal trauma and need for suturing perineal trauma. There is no difference in risk of severe vaginal or perineal trauma, pain, dyspareunia or urinary incontinence. There is, however, a somewhat increased risk of anterior perineal trauma. The review does not resolve the question of what type of episiotomy should be preferred, midline or mediolateral.

All appropriately controlled trials that could be identified have been included.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research

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This document should be cited as: Jerker Liljestrand. Episiotomy policies in vaginal births: RHL commentary (last revised: 20 October 2003). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com