Episiotomy, First and Second Degree Tears

Eighty-five percent of women who have a vaginal birth will sustain some form of perineal trauma and up to 69% of these lacerations will require suturing. However, these rates can vary considerably according to the policies of individuals and institutions throughout the world. There is little evidence of sound methodological quality to support non-suturing of first and second-degree tears. Therefore, practitioners must be cautious about leaving trauma unsutured, unless it is the explicit wish of the patient. For second degree tears and episiotomies, continuous suturing (versus placement of interrupted sutures) for perineal closure (all layers or perineal skin only) are associated with less pain for up to 10 days postpartum, an overall reduction in analgesia use, and less need for suture removal. Current evidence suggests that the more rapidly absorbed polyglactin 910 (Vicryl rapide®) is the most appropriate suture for perineal repair. There is known discontent amongst trainees (doctors and midwives) with their comfort in perineal repair, suggesting that more intense and focused education and training should be provided.