I feel I’m in the minority when I use this method—as though I’m carrying on an “old school” tradition. But, now, after reading Dr. Barbieri’s editorial, it seems to me that attitudes are coming full-circle. As we have moved from routine use of episiotomy to calling it a “surgical intervention,” I am reminded daily of the nature of our job—to afford a safe and healthy delivery not only for the baby but the mother as well.
Lynn-Marie Aronica
Buffalo, New York
Perform mediolateral episiotomy when necessary
After practicing for 20 years, I know how to use forceps, so I always perform mediolateral episiotomy if I feel one is needed. Allowing the patient to tear is an acceptable alternative to performing an unnecessary small midline episiotomy. However, I would never perform a midline when there is a real risk of an extension.
Alison Wright, MD
Warner Robins, Georgia
Dr. Barbieri responds Increased benefit to the mother
I thank Dr. Aronica and Dr. Wright for taking the time to share their perspectives on the role of episiotomy in obstetric practice. Our readers have a wealth of high-quality practice pearls developed during decades of clinical experience. The editorial team at OBG Management is very appreciative of our readers who write to share their insights with our physician audience.
I agree with Dr. Aronica that liberally performing median episiotomy, which was my past practice, gave us the opportunity to repair third- and fourth-degree extensions but may not have provided sufficient benefit to the mother to warrant the liberal use of the procedure.
I agree with Dr. Wright’s recommendation that the combination of a planned operative vaginal delivery and an exam that suggests a large fetus should guide all obstetricians to strongly consider performing a mediolateral episiotomy, if an episiotomy is indicated, in order to reduce the risk of a third- or fourth-degree tear.
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