The first use of an episiotomy to facilitate the delivery of an infant is lost in the past. Whether ancient midwives or birth attendants used primitive knives has been questioned for years. Perhaps they did or perhaps they did not. What is known, however, is that intentional incision of the perineum was not practiced as a routine procedure until the 20th century.
Treatises on management of the perineum as the fetal head emerges at the time of delivery focused on protecting against tears and lacerations. In the 1700s, the usual description of a delivery of the infant’s head concentrated on preserving the intact perineum by allowing a slow, controlled dilation and delivery by exerting pressure on the perineum (1) .
In 1828, Ferdinand von Ritgen described a similar maneuver for easing the head over an intact perineum (2). His procedure, which he modified to use extension rather than flexion of the head, also was designed to prevent trauma to the perineum while facilitating the delivery (3) . This was accomplished by placing the examiner’s fingers on the perineal body and gently pushing the head from flexion to extension.
This maneuver is still perfo rmed in deliveries today and is known as the Ritgen maneuver.
Types of Episiotomy
Basic Anatomy of the Perineum
Pain and Dyspareunia
Title: Episiotomy Procedure and Repair Techniques
Authors: RALPH W. HALE, FRANK W. LING
The American College of Obstetricians and Gynecologists