Interventions: Epistomy & Amniotomy

You and your partner or birth companion can be involved in making decisions about your obstetrical care.

Some of the procedures described in this article were once carried out routinely. We now know, however, that certain procedures may be beneficial in certain circumstances, and other interventions should be abandoned altogether. Some interventions may be implemented when you give birth, but should be done in response to the needs of your particular situation.

Ask about your hospital or birthing center’s policies on the various interventions. You should also ask your doctor or midwife about their beliefs and practices regarding these interventions. Knowing what your options are well before your due date will eliminate surprises and give you a chance to think them over.

Should a situation arise in which an intervention is suggested, you will have the knowledge to ask informed questions, such as:

1. What are the benefits and risks?
2. Does this intervention have to be done right away?
3. Are there alternatives to the intervention, and what are they?

Shave Prep & Enema
Experts agree that these are unnecessary procedures during childbirth. They are no longer recommended as part of routine obstetrical care.

Episiotomy
An episiotomy is a cut made by the doctor or midwife at the opening of the vagina.
Episiotomies are sometimes used to hasten the birth when there is a concern for the mother or baby, when the perineum is preventing the baby from coming out, or when forceps are being used.

There are two types of episiotomies:

• Most episiotomies done today are midline (also known as median), which involves a cut from the vaginal opening toward the rectum.

• In a mediolateral episiotomy, the cut goes down from the vagina, then toward one thigh.

Episiotomies do not appear to prevent severe tearing of the perineum, and may make tearing worse. Like a piece of cloth, skin will tear easier and further if cut first.

Research shows episiotomies are not less painful than tears, nor do they heal better. Episiotomies do not prevent urinary stress incontinence, nor do they improve sexual satisfaction after delivery.

Manual massage of the perineum before and during labour may help prevent tearing.

Amniotomy

An amniotomy is the artificial rupturing of the membranes of the amniotic sac or ‘water bag.’ This is done to start or speed up labour. The membranes are broken using an instrument similar to a crochet hook.

This procedure will not hurt you or the baby. It is done during a vaginal examination. If the procedure is being done to begin labour, the exam may be more difficult than later on, as your labour progresses and the cervix is opened.

For some women, the water will break spontaneously before or during labour. For other women, labour progresses with the membranes intact. Therefore, amniotomy is only needed in certain situations.

Amniotomy in the early stages of labour has been shown to decrease the duration of labour by an average of one to one-and-a- half hours. Women have also reported experiencing fewer periods of ‘excruciating’ pain during labour following amniotomy.

• The effects of amniotomy on the baby are not fully known. Amniotomy can increase the risk of infection in the uterus. LB

Theresa Agnew, RN, BScN, BA (SDS), is a former instructor in the School of Nursing, Ryerson Polytechnic University and is a former prenatal instructor. She now works as a nurse practitioner at a community health centre in Toronto, Ont.

Roseanne Hickey works at Sunnybrook and Women’s College Health Sciences Centre as a nurse in labour and delivery and has taught prenatal classes for many years.

Published in March 2007