The unkindest cut?

Routine prophylactic episiotomyIs it always necessary?

“…Varney 13 begins her discussion of episiotomy with a guide for evaluating the mother and baby to determine whether or not an episiotomy is needed. Cogan and Edmunds 14 conclude that the literature on episiotomy is absence of clear evidence as to the advantages of the procedure. They have found no data showing a positive relationship between episiotomy and subsequent maternal or infant health in births that are not forceps assisted 14 …”

The place of episiotomy in history: A sore review

“…• Between 98-138 DC: the earliest records regarding care of perineum during delivery, which were predominantly medical and firstly done by a doctor-Soranuswho emphasized the importance of applying warm cloths and lipid lotions to the perineum [5] • Between 476 and 1000 DC (the Dark Ages): midwives have become the target of persecution and their manuscripts were destroyed by the Church, thereby losing track of their wisdom -and we believe that, for this reason, the ancient written documents by midwives are scarce. • During the 11th century several works were published by the first medical school in Salerno, apologist that the perineum should be supported by linen cloths and there was a warning for the risk of severe trauma if this measure were neglected.…”

“…[1] In the USA in a short period of few years (1918-1920) thanks to the Pomeroy and De Lee publications, it was verified a philosophical change in the episiotomy use, becoming a routine based on four strongly beliefs: it prevents lacerations, decreases delivery length, reduces neonatal morbidities as well as the occurrence of gynaecological prolapses. [5,[12][13][14] Apparently, De Lee advocated too that routine episiotomy would prevent the newborn from having a criminal life. [9] It was indiscriminately settled an invasive procedure, devoid of scientific scrutiny.…”

Maintenance of pelvic floor integrity during childbirth

“…The currently available knowledge and speculations concerning the use of episiotomies raise many unanswered questions. There are medical circumstances when an episiotomy is a valuable procedure and should be performed; whether a prophylactic episiotomy is truly of benefit to the mother or infant remains to be determined 1,2 . While that controversy continues, we and the women we serve are faced with making daily decisions about the episiotomy issue.…”

“…The hypothesis that an episiotomy helps maintain subsequent male or female sexual response by making a tighter introitus has also never been researched 1 . The “husband's knot” does not restore pelvic floor function for the woman, it merely makes the vaginal entrance a little tighter, resulting in structural rather than functional improvement 11 .…”