Tuesday, November 6, 2012

Episiotomy

Suggest that we consider together, in light of the results of new research in this area, which are the most common reasons to use routine episiotomy. The upshot is upon you.


Childbirth may occur cracks tissue. There are three degrees of cracks:

First the minimum degree of rupture of the perineum, ie. tissue and requires no special treatment other than good hygiene;
Second degree of cracking - usually easily stitched under local anesthetic, usually zarašćuje quickly and without consequence;
3rd degree cracks - can have serious consequences, so would need to sew the obstetrician-equipped hospital, but such spontaneous cracks occur very infrequently (0.4 percent) (document on natural childbirth WHO) in some literatures I found information about
4th degree of cracking, it is the most severe form and the most severe consequences when there is a gap sphincter, rectum, etc..


"It'll crack you will barely be able to sew!"

The biggest argument for episiotomy is to "protect the perineum from injury," and this protection is achieved by cutting the perineum, connective tissue and muscle. One group holds that spontaneous Obstetricians rasjekotine do more damage, but new research proves that deep cracks almost exclusively continuation, ie. consequences of episiotomy. It has meaning.

Harrison described it picturesquely: "Try to think of episiotomy is this: if you hold a piece of cloth and stretch it, intending to tear it in two, you know yourself how much resistance creates the fabric itself, and will rarely break. But if you make a small cut in the middle, stretching will easily achieve the goal.Performing an episiotomy is just that, so that sometimes occurs even split up the rectum. Doctors are still debating whether the "clear" incision easier to treat, as opposed to rupture that occurs without cutting. My experience is that these small cracks that occur without episiotomy stitches easier and less painful for the woman. Episiotomy, and made a "patched", it is much worse and is a source of much greater pain in the postpartum period. "(1982:97 Harrisnon)

Celebrities are many other statements and confirm that obstetricians who "never had a puncture in thirdand 4 degree through the sphincter or rectum if they are not doing an episiotomy. "This was confirmed in a parallel study on hospital and home births, where episiotomies performed nine times in hospital births, followed by nine times more frequent and severe perineal injuries (grade 3 and 4 ).

Another study in 241 primiparous women who gave birth in hospital, shows that the ratio of deep cracks was the lowest (0.9 percent) in women without episiotomy and were not confined to the supine position, the highest percentage of deep cracks (27.9 percent) was found in women who are gave birth in stirrups and episiotomy. (Borgatta et al. 1989:295) This proves that the position in which women give birth has a major impact on the incidence of spontaneous rupture.

The truth is that episiotomies are rarely needed when a woman gives birth in a squatting position bolstered.This position provides maximum pelvic pressure, optimal muscle relaxation, a great expansion of the perineum, and minimum muscle strain. He is also the best prevention against severe perineal laceration.When a woman lies on her back with her legs in stirrups and trying to displace against gravity, is likely to start in a deep laceration tissue below the skin surface. However, propped in a crouched position, any laceration will usually be superficial and will heal quickly. (Michel Odent)



Wound healing and the possibility of infection

Episiotomy, like any other surgical interventions, has its risks: blood loss, poor wound healing and infection. Such infections are very painful. The stitches must be removed to drainaging natural healing, and then re-sew. The incidence of infections due to episiotomy is 3 percent. (Thacker and Banta 1983)

Moreover, there are two very rare gangrenous infection (necrotic inflammation of the fascia, clostridial mionekroza) which are deadly, and women who manage to survive will remain crippled. Although these infections are rare, they are still an important cause of maternal mortality. Between the 1969th and 1976.these infections are caused death in 27 percent of cases (3/11), testing was done in California. (Kern County, Ewing, Smale and Elliott 1979).. Since all the deaths occurred in healthy women who had complications in childbirth, we can say that the cause of death was literally - episiotomy!

If a woman does not have an episiotomy, it will probably have a small crack, and very rarely will the cracks, even the largest, would be worse than the episiotomy. No research has failed to prove that episiotomy reduces the incidence of cracking third and 4 degree, but many have shown that the medial (central) episiotomy is closely associated with deep rasjekotinama. (Am J Obstet Gynecol 1989; 160:1027-1030.)

Regarding wound healing, proved just better healing perineal area in women without episiotomy versus those with her. The study comprised of 181 women with episiotomy, and 186 women without episiotomy (degree episiotomy 49 percent), comparing the perineal wound in a period of 1-2 weeks after the birth. All the patients had spontaneous labor with no complications. Only 2 percent of women in the group without episiotomy had a puncture in third level, as opposed to another group where they stood at 15 percent (grade 3 and 4). In the group of women without episiotomy was 53 percent of mothers with a fully intact perineum! None of the four third crack degree (without episiotomy) not long healed, as opposed to 18.5 percent, ie. 27 third crack and 4 degree (with episiotomy). The team's research showed that episiotomy increases the risk of infections, including fatal infections, causing short-term and long-term pain and dispareuniju (pain during intercourse), and that causes a "significant" loss of blood .. (M. McGuiness, K. Norr, K. Nacion, Comparison between different perineal outcomes on tissue healing; Nurse Midwifery 1991).



Prevention of uterine prolapse, incontinence, etc..

It is believed that due to over-stretching of the pelvic floor muscles during childbirth leads to their subsequent relaxation, which leads to the inability to hold urine and controlled falling uterus. However, older women who have had the plastic (corrective) surgery for the reasons stated above, all had large episiotomy. In any case, the episiotomy is done only when the head of a child ready to be born. By this time the muscles of the pelvic floor is already fully stretched. No one has ever managed to explain how cutting the muscle and the re-combination, can increase its power. (Lobb, Duthie and Cooke 1986).

Michel Odent writes about it: "Conventional obstetricians have tried in every way to justify their practices.They argue that episiotomy reduces the likelihood of future prolapsiranja uterus, although there is no scientific evidence for this hypothesis. In my surgical practice, I found it was likely to occur when the uterus prolapsiranje doctors artificially accelerate labor, more onerous muscles, give birth or forceps, which can really hurt your muscles. The fact is that epizotomija routine and are usually performed without reason. It's even more frustrating when you know that a woman can create pain for weeks and sexual problems. Such complications do not occur often after natural laceration to heal much faster than epizotomija. "

Prevention of neonatal brain damage

This is probably the most absurd principle, which claimed that the neonatal brain damage occurs because of "the pressure of the head on the perineum." Female perineum is soft and elastic tissue, not concrete. No one has proved that episiotomy protects neurological status of the newborn, or even those with the lowest birth weight and premature births. (Duthie and Cooke 1990).

Research results indicate that routine episiotomy has little or no beneficial effects on the birth of infants with low (less than 2500g) or very low birth weight (less than 1500g), and premature babies. One of the two allegations of episiotomy and its protective effect, is to reduce the pressure on the head of a newborn.However, to achieve this, episiotomy should be done before the head is stretched perineum. The second claim is the shortening of the second stage of labor. However, the length of the second stage of labor is not a consistent correlation with the moment of birth. (Is routine episiotomy beneficial in the LBW delivery?, Gynaecol Obstet 1990).

The assumption that episiotomy protects the fetus from damage to the unproven assumption doctor, who thus reveal their deep-seated belief that the fetus, their products, the risk of poorly functioning appliances maternity mother.



Text written by: Emy De Bombol

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