Perineal trauma: A historical and international perspective

Abstract

Review of historical literature confirms that perineal injury has occurred during childbirth throughout the ages and that various methods and material were used by accoucheurs in an attempt to restore the integrity of severely traumatised tissue. Perineal stitching following childbirth was advocated in ancient writings on midwifery and obstetrics, however the procedure was not routinely practiced. Women remained the prominent figure during confinements in the early centuries and male physicians or barber-surgeons were only called in as a last resort if problems occurred. During the eighteenth century the introduction of forceps together with episiotomy to facilitate difficult deliveries had a major impact on the extent of perineal trauma and its subsequent repair. Furthermore, women were encouraged to deliver in a more supine position rather than upright so the perineum was more accessible and the full extent of perineal trauma sustained could be assessed. During this period more attention was made to minimising perineal trauma and various methods including supporting the perineum and applying pressure to the vertex to prevent rapid expulsion were implemented. By the end of the nineteenth century practitioners were advised to suture all perineal trauma. However, it was not until the early twentieth century that local anaesthetic was advocated to ease the pain prior to performing and suturing episiotomies. In the UK, midwives did not receive any formal training until the late eighteenth century and it was not until the late twentieth century that midwives were permitted to undertake perineal suturing.