Is It Possible to Never Perform Episiotomy During Vaginal Delivery?

Abstract

INTRODUCTION: The beneficial effects of a restrictive policy of episiotomy for vaginal deliveries have been demonstrated. However, the ideal rate of episiotomy is not known and some studies describe rates less than 5%. The aim of this study was to describe the outcomes of a protocol of no episiotomy within a large project for humanization of childbirth care. METHODS: A cohort study including 400 women who had vaginal deliveries in a school maternity in northeastern Brazil. During the second stage of labor, maneuvers such as directed pushing, fundal pressure, and Valsalva maneuver were avoided. A policy of no episiotomy was followed with strategies for perineal protection that included warm compresses and intrapartum perineal massage. RESULTS: The majority of births (85%) was assisted in the upright position (birthing chair or stool). There were 18 cases of forceps and six cases of vacuum extraction (6%). No episiotomy was carried out (0%), 56% of women had an intact perineum, 13% had first-degree perineal lacerations without suturing, 7% had first-degree perineal lacerations requiring suture, 8% had second-degree perineal lacerations without suture, and 16% had second-degree lacerations requiring suture. The overall suture rate was 23%. There were no third- or fourth-degree perineal lacerations. Women satisfied or very satisfied with the care corresponded to 96%. CONCLUSIONS: It is possible to reach a zero rate of episiotomy with a high frequency of intact perineum, reduced need for suturing, and no adverse outcomes such as severe perineal lacerations.