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Saving the perineum

The guideline contains two contradictory statements

Statement 1:
"Routine episiotomy [perineal incision] during spontaneous vaginal delivery should not be performed." (8.13) (16)

stop saving perineum pixabay freeFoto: Pixabay free
Statement 2:
"If an episiotomy is performed, it should be performed mediolaterally." (8.14)

What is meant by statement 2? The vaginal outlet appears oval. Starting from the lower center, towards the anus, the tissue should be cut at an angle of approx. 45 °. This is fraught with consequences, because nerve tracts, blood vessels, muscle fibers and connective tissue are cut as well. This injury leads to delayed healing and sometimes pain lasting several weeks. In bad cases, this later leads to problems with intimate intercourse. This in turn can make a happy partnership difficult.

The 2nd statement (8.14) on episiotomy is rejected by the associations Mother Hood e.V. and Arbeitskreis Frauengesundheit e.V. (AKF) - members of the Guidelines Commission. Their statement culminates in the sentence:

"[We] therefore criticize the recommendation for an intervention that has a high probability of harming the sexual health of the mother, whose evidence base [scientific evidence] is inadequately presented, and for whose fundamental benefit evidence is lacking. Further research on the fundamental benefit of the measure is requested. Recommendation 8.14 can be deleted because Recommendation 8.13 is deemed sufficient." (10)

With movement and an upright posture, you help your baby come into the world. You will need less medication and fewer pain medications. Your pelvis widens to make room for the baby. Perineal incision as a routine is no longer recommended. You can mention that you do not agree to an episiotomy as a routine when you register at the clinic.

(10) Mother Hood e.V. and the Arbeitskreis Frauengesundheit e.V. (AKF), as members of the guideline commission, give detailed reasons for their rejection of an episiotomy according to guideline 8.14. For more information, see the long version of the S3 guideline Vaginal Birth at Term.
(16) These numbers refer to the location in the abbreviated version of the guideline "Vaginal Birth at Term."

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