Episiotomy. A Routine or a Choice.

The benefits and risks of routine procedures within medicine over the
last twenty years have become increasing questioned. For some years now episiotomy has been a subject of much debate. In more recent years the scope of interest relating to episiotomy has developed more widely from the obstetrician to women who have experienced an apisiotomy. In some ocuntries virtually all the women having an episiotomy. Recent national estimates for proportions of vaginal births assompanied by episiotomy are 28 percent in England and Wales, 50 percent in United States and 38 perxent in Canada. The procedure is not routinely recommended in the United Kingdom and there is a controversy about how many should be performed. Many studies relating to episiotomy have primarily been concerned with when and how to perform the procedure. A number of different influences have affected the way women view episiotomy. There is evidence from the literature, with the increasing trend towards medicalization, that episiotomy has been viewed as an agent of social control. Recently the
House of Committee Second Report on Maternity Services (1992) concluded that until such time as there will be more detailed and accurate research about such intervention as episiotomy, women need to be given a choice on the basis of existing information rather than having to undergo such interventions as routine. Obstetricians in Greece continue to instruct health staff to apply a policy of "avoid tears-do episitomies" routinely. They may be acting in good faith, but the shows that they are wrong. The World Health Organisation has taken a clear stand against routine episiotomy, in the with the best available evidence. Taking these points into consideration it is evident that there is a need to answer the following questions: (a) Are women made to feel they have a choice as far the use of episitomy is concerded? (b) What effects doew episiotomy have on them? Episiotomy is a commonly performed surgical procedure of childbirth but globally the rates vary considerably. Health professionals have always sough to base their decision on the best possible evidence. Researchers indicate that routine performance of episiotomy during an uncomplicated labour presents greater risks than benefits to the childbearing woman. In the United Kingdom, public concern and studies undertaken have seen the decline of episiotomy use. The decline in the use of episiotomy is however not the case in Greece.

Keywords: Perinium, episiotomy, perinealtears, vagial delivery