Lepisiotomyi.e. the incision of the perineum to facilitate the exit of the baby, has long been considered necessary during a first birth. The technique is now practiced in 20% to 30% of deliveries in France. It is practiced in specific situations, especially when the release of the baby is likely to cause spontaneous tearing, vaginal or even anal. In our audio rendezvous “ Everything is explained », listen to Bruno Deval, professor of gynecology and obstetrics, about the interest, or not, of performing an episiotomy. Of its advantages and disadvantages, as well as the interest, or not, of the cesarean section. Bruno Deval is the author of The female perineumto the Editions du Rocher.
A technique that must be consented
In this interview, the doctor recalls that “the episiotomy must be done with the patient’s agreement. If the woman refuses, we don’t have the right to do it, because it’s not mutilation, but it could be affiliated with a obstetric violence “.
The episiotomy has a major interest, that of facilitating the arrival of the baby. The technique also has its drawbacks. The doctor lists: “it does not prevent postpartum urinary or anal incontinence, and above all it hurts. It can be complicated, with either disunions, hematomas, infections. And women sometimes complain of flanges at the level of the vagina, and altered sexual relations. »
The practice of episiotomy has evolved. Today it is less practiced on people giving birth for the first time. “When I was an intern, some twenty years ago, I was in a ward at the Saint-Antoine hospital in Paris, where all the primiparous [personnes accouchant pour la première fois N.D.L.R.] had an episiotomy. We realized that episiotomy did not protect against urinary incontinence, nor anal incontinence (…) we decided that episiotomy should no longer be systematic”.
Interest, or not, of the cesarean section?
Finally, for fear of undergoing an episiotomy, or for other reasons, some people about to give birth ask for a caesarean section. This “comfort caesarean” can also have advantages, but also disadvantages, recalls the professor of medicine. “After three caesarean sections, the incontinence rate is identical to the incontinence rate after vaginal delivery,” emphasizes Bruno Deval. “In my opinion, all of this must be discussed” between the patient and her obstetrician, recalls the doctor. He also advises preparing your perineum with massages from the 32nd week of pregnancy, to avoid having an episiotomy. Listen to all the answers from Bruno Deval, professor of gynecology and obstetrics, in the audio player above.
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