Vaginal tears can occur during childbirth, most often at the vaginal opening as the baby's head passes through, especially if the baby descends quickly.<unk>  is done in an effort to prevent against soft-tissue tearing (perineal tear) which may involve the anal sphincter and rectum. Tears can involve the perineal skin or extend to the muscles and the anal sphincter and anus. The midwife or obstetrician may decide to make a surgical cut to the perineum with scissors or a scalpel to make the baby's birth easier and prevent severe tears that can be difficult to repair. The cut is repaired with stitches (sutures). Some childbirth facilities have a policy of routine<unk> . Specific reasons to do an<unk>  are unclear. Though indications on the need for<unk>  vary and may even be controversial (see discussion below), where the technique is applied, there are two main variations. Both are depicted in the above image. * In one variation, the midline<unk> , the line of incision is central over the anus. This technique bifurcates the perineal body, which is essential for the integrity of the pelvic floor. Precipitous birth can also sever—and more severely sever—the perineal body, leading to long-term complications such as incontinence. Therefore, the oblique technique is often applied (also pictured above). * In the oblique technique, the perineal body is avoided, cutting only the vagina epithelium, skin, and muscles (transversalius and bulbospongiosus). This technique aids in avoiding trauma to the perineal body by either surgical or traumatic means. In 2009, a Cochrane meta-analysis based on studies with over 5,000 women concluded that: "Restrictive<unk>  policies appear to have a number of benefits compared to policies based on routine<unk> . There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive<unk> ". The authors were unable to find quality studies that compared mediolateral versus midline<unk> .
Episiotomy
Tubal reversal
Tubal ligation
Uterine balloon tamponade
Trial of labour
Forceps
Pelvic massage
Labor induction