This essay will examine evidence relating to the use of episiotomies in preventing severe perineal trauma during childbirth. This is defined as third and fourth degree tearing and obstetric anal sphincter injuries (OASIS). An episiotomy is an incision into the tissues surrounding the opening of the perineum. The procedure is typically performed during a difficult birth. Often, it is used as a preventative measure to enlarge the opening in a controlled manner, to make delivery easier and to avoid extensive tearing of adjacent tissues. Episiotomies were initially developed to prevent perineal trauma during deliveries, most importantly third and fourth-degree lacerations (Muhleman et al, 2017). These severe lacerations often have long term implications …show more content…
de Leeuw et al. (2007) concluded that mediolateral episiotomy has a protective effect against OASIS in operative vaginal deliveries. Also, Keriakos and Gopinath, (2015) conducted a large observational study in the Netherlands of 28 732 operative vaginal deliveries. They concluded that mediolateral episiotomy is protective against severe perineal trauma and OASIS in both ventouse and forceps deliveries. Although, this evidence cannot be applied to a UK context as the Netherlands has a very different approach and culture surrounding birth. During an instrumental vaginal delivery, the perineum is manually stretched to a greater extent than it otherwise would be in a non-instrumental vaginal delivery. Thus, it is more susceptible to severe trauma, such as third and fourth degree tears and OASIS. Therefore, according to NICE (2017) an episiotomy should be used routinely with operative births as a protective measure. The main indication for operative vaginal delivery is fetal distress and so episiotomy also allows for a quicker delivery of the neonate, preventing potential for fetal compromise, as well as protection of the mother from severe perineal