Intact perineal is the hoped outcome after VD. However, some times during the delivery of the baby, the head will cause a distension of the perineal area which can lead to perineal tear, which is a common complication during VD. Collins et al, classified perineal tears as the following, 1st degree (1D) that include the skin only, 2nd degree (2D) injury will involve the anal sphincter skin and muscle, 3rd degree (3D) involve anal sphincter complex and the most severe degree is 4th degree (4D) that contain injury of sphincter complex and anal mucosa. (2013, p.302)
Even though perianal tear is common, SSL that include third and fourth perineal tear, have a direct effect in reducing women’s quality of life by causing series complication including severe pain, anal incontinence, dyspareunia and altered sexual function (Harvey and Pierce, 2015, p.1133). …show more content…
However, the world health organization (WHO) and many other studies don’t recommend the use of episiotomy as a routine procedure to prevent SSL and suggested to use it only when needed, therefore a specific guidelines were developed to limit the use of episiotomy (Al-Ghammari et al, 2015). Even though, according two studies study done by Al-Ghammari et al in Oman (2015) and Saudi in a study done in Saudi Arabia (2014), relived that episiotomy rate still significantly high among primigravida. Additional to These two studies, a study done in Phnom Penh by Schantz et al, questioned the midwiferies for performing episiotomy in each case, the most common reason is to prevent SSL which would be harder to sutured comparing to episiotomy in additional to preventing maternal complication. The second most used reason was that episiotomy is a common recommended practice for primigraveda (2015,