Episiotomy Versus Natural Lacerations

Anna Clair Logan, India Perryman, Rachel Senyitko, Megan Vaughn, Rachel Wylie

PICO: In post-partum women, what
is the effect of an episiotomy versus
natural lacerations on post-partum
perineal recovery?
Significance: Understanding the risks
versus benefits of episiotomies or
natural lacerations will lead to better
outcomes for patients regarding post-
partum recovery.

Review of Literature:
Episiotomy for vaginal birth (Carroli & Mignini, 2012)
Level I
Outcomes of Routine Episiotomy (Hartmann et al.,
2005) Level I
Episiotomy and perineal tears presumed to be imminent
(Dannecker et al., 2004) Level II
Pelvic floor disorders four years after first delivery
(Fritel et al., 2007) Level IV
Effects of perineal trauma on postpartum sexual
function (Rathfisch et al., 2010) Level V
Effects of episiotomy on bonding and mothers health
(Karaam & Erolu, 2003) Level V
Impact of episiotomy on pelvic floor disorders and their
influence on womens wellness after the sixth month
postpartum (Bertozzi et al., 2011) Level V





Method:
Research from Academic Search Premier, MEDLINE,
CINAHL, PsychINFO, Health Source:
Nursing/Academic Edition, and Cochrane showed
consistent evidence about post-partum recovery
following perineal trauma. Key words that were used
while searching for articles included episiotomy
perineal tears perineal trauma perineal pain
lacerations postpartum complications sexual
function incontinence and vaginal delivery.
Synthesis
Pain that was reported by those who had natural lacerations was
reported less severe than the pain of those with episiotomies (Karaam
& Erolu, 2003).
There was no difference in the incidence of post-partum urinary
incontinence between the episiotomy group and the spontaneous-tear
group (Hartmann et al., 2005). However there was an increase of
reported incidences of anal and flatus incontinence in the episiotomy
group (Fritel et al., 2008).
Studies show that it is vitally important to the resumption of sexual
intercourse to limit perineal trauma during childbirth by avoiding
episiotomy (Rathfisch et al., 2010). In addition, women with
episiotomies are more likely to report pain with the first post-partum
intercourse (Hartmann et al., 2005)
Studies showed that the episiotomy group had a longer mean time
from delivery to mothers rest, which delayed the bonding between
mother and baby. Early establishment of breast feedings and bonding
are vital and can be delayed when an episiotomy is performed
(Karaam & Erolu, 2003).
While a few women may benefit from episiotomies, generally the
risks outweigh the benefits. Spontaneous lacerations that occur as a
result of restricting the use of episiotomy carry much less of a risk and
have far more benefits (Bertozzi et al., 2011).
Recommendations:
Mediolateral and Midline episiotomies
should be avoided even if a tear may be
imminent.
Grade: A
Midwives and obstetricians need to be
educated on new evidence on the
advantages and disadvantages of
episiotomies.
Grade: A
Limiting perineal trauma during delivery
is important for the resumption of sexual
intercourse after childbirth.
Grade: A
Mother and baby bonding should start at
once, not at completion of perineal repair
Grade B




Discussion:
Health care providers should review new
evidence that support a more restrictive
episiotomy policy. In order to limit
perineal injury in the post-partum
woman, standard indications for an
episiotomy should be determined.
References:
Bertozzi, S., Londero, A.P., Fruscalzo, A., Driul, L., Delneri, C., Calcagno, A. , Di Benedetto, P., Marchesoni, D. (2011) Impact of episiotomy on pelvic floor disorders and their influence on womens wellness after the sixth month postpartum: a retrospective study. BMC Womens Health. 11(12), 1-7. doi10.1186/1472-6874-11-
12
Carroli, G., & Mignini, L. (2009) Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, 2009 (1), Article CD000081. doi:10.1002/14651858.CD000081.pub2.
Dannercker, C., Hillemanns, P., Strauss, A., Hasbargen, U., Hepp, H., &Anthuber, C. (2004). Episiotomy and perineal tears presumed to be imminent: randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica. 83. 364-368.
Fritel, X., Schaal, J. P., Fauconnier, A., Bertrand, V., Levet, C., & Pign, A. (2008). Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy. BJOG: An International Journal Of Obstetrics & Gynaecology, 115(2), 247-252. doi:10.1111/j.1471-0528.2007.01540.x
Hartmann, K., Viswanathan, M., Palmieri, R., Gartlehner, G., Thorp, J., & Lohr, K. N. (2005). Outcomes of Routine Episiotomy: ASystematic Review. JAMA: Journal Of The American Medical Association,293(17), 2141-2148.
Karaam, Z., & Erolu, K. (2003). Effects of episiotomy on bonding and mothers health. Journal Of Advanced Nursing, 43(4), 384-394. doi:10.1046/j.1365-2648.2003.02727.x
Rathfisch, G., Dikencik, B.K., Beji, N.K., Comert, N., Tekirdag, A.I. & Kadioglu, A. (2010). Effects of perineal trauma on postpartum sexual function. Journal of Advanced Nursing. 66(12), 26402649. doi: 10.1111/j.1365-2648.2010.05428.x