GynoFiles

The Episiotomy Cut: Debate 2012: In 1935 Aldridge and Watson published their theory that performing an episiotomy would protect the mother’s pelvic muscles. They felt that all sorts of protection would be conferred, including prevention of prolapsed uterus. By the 21 st century obstetricians were looking at all the factors leading to bladder incontinence and weakness of the pelvic floor muscles, and it was hotly debated as to whether these episiotomy cuts would be helpful or harmful. The subject is complicated by the fact that women have some bladder dysfunction, and prolapse, immediately after delivery that resolves relatively quickly. The dysfunction immediately after delivery probably comes from temporary weakness or paralysis of nerves of this area, secondary to the baby’s head pounding against the pelvic floor and it’s muscles. In a study published in Obstetrics & Gynecology in 2012 a group of researchers   from the Johns Hopkins School of Medicine looked at women 5 ...

Women do not want to tear in the process of birthing and it is known that in the pushing stage of labor as the baby’s head is pushed forward against the opening of the vagina the passageway does open to allow for a trauma free birth. What we want to talk to our patients about is how to best avoid those tears. In Rates of episiotomy has varied over the past years and now only about 1/3 of women will get an episiotomy (cut in the vaginal opening to make more room for the birth), and most of those are done to specifically speed up the birth in cases where the medical situation warrants a more rapid delivery. Interestingly in the not too distant pass we used to have episiotomy rates of about 90%, and it really was being performed electively. Now we don’t do the episiotomy and in some hospitals this means that almost 3 of 4 women will have a tear, but actually in some hospitals the percent of women who actually tear is less than 10%. In this post we will discuss some of the ways. S...

Most women who have had a delivery know the word episiotomy, we never had to learn it for scrabble, pretty much too many letters, but we had to learn it for birthing. It's the cut between the vagina and rectum that makes more room for the baby. And most know that the cut can be made straight towards the rectum, essentially at the "6:00 o'clock" position, and it's a risk for a major rectal tear, but on the other hand can make a lot of room. The other option is to go towards the edge or your leg, and sort of towards the butt, and not straight down in sort of a "8:00 o'clock" slant. It's even a bigger cut, but it does tend to avoid cutting into the rectum. It's more likely to heal a bit worse (in many studies, not all) so we tend to cut down. But then there are those that do the J. They cut down and then do a bit of a right turn to avoid the rectum. Sort of looks like a change of course. But then again, perhaps it's a just in time miss th...

It's been an odd trend in obstetrics, the rates of episotomies have been in the opposite direction as C-sections!! In the past when obstetricians did an episiotomy they were able to avoid some of the c0-sections. Now women have been hoping to avoid. When epidemiologists want to find out what physicians are up to , they check in with the National Hospital Discharge Survey . It's a set of information tracked by the National Center for Health Statistic s.In 1979 if an operative vaginal delivery occurred it was much more likely to be delivered by forceps and forceps and/or vacuums and the vacuums in those days pulled more pressure and thus were successful at helping achieve a vaginal delivery more so than they even are today. As a result there was about 85% episiotomy rate during that 70s era. If there was a spontaneous delivery, no forceps or instruments used, then about 50% of births had episiotomies. In 1989 the stakes rose and a virtually 90% of women who delivered with a va...