THE PRACTICE OF EPISIOTOMY: ANALYSIS BASED ON THE CURRENT SCIENTIFIC EVIDENCE

Abstract

 Historical reminder: the use of episiotomy has been the object of multiple controversies throughout history. Our objective is to analyze the current knowledge regarding the practice of episiotomy and what role obstetric Physiotherapy might have relating to such practice. Current scientific evidence: the current scientific studies demonstrate that routine episiotomy doesn't constitute a protective factor for the feminine pelvic floor and can also produce a whole series of harmful effects upon the same. Because of this, nowadays the World Health Organization recommends a restrictive use of this practice of around 10-20 % including nullipara women. Nevertheless, as consequence of the results found in some studies, there exist divergent opinions that we are going to analyze throughout this study. Possible therapeutic alternatives: based on the results that appear in the scanty scientific studies done and in our clinical experience, we think that Physiotherapy (perineal massage, pelvic floor exercises...) might have a crucial role to obtain an effective decrease of episiotomy rates and spontaneous perineal tears. Final conclusions: the practice of routine episiotomy as a type of preservative should be avoided, opting for its selective use. The combination of the medial episiotomy and natural birth with forceps seems to constitute a more important risk factor for the feminine pelvic floor. To reduce the episiotomy rates and spontaneous perineal tears it would be interesting to implant preventive physiotherapy measures scientifically supported in daily practice with pregnant women.