An Episiotomy

You may think that an episiotomy is just a routine procedure during child birth. Or you may have never heard of it.

Here is what Henci Goer in her book Obstetric Myths Versus Research Realities: A Guide to the Medical Literature has to say:

Note: As you read this, remember that the most common way doctors describe an episiotomy is as a "little cut," which implies that it is a trivial matter...the truth does not reflect this however.

So let's address the basics, shall we?

What is an Episiotomy?

According to Wikipedia an episiotomy is:

Notes:

Just a thought: the decline in episiotomy frequency may be due to the increase in cesarean section.

It is a lie to say that episiotomies are performed under local anaesthetic...the majority of the time they are NOT! And yes, they do hurt...a lot!

In the United States, the midline episiotomy - cut straight back into the perineum - is the standard. This type of cut leaves you vulnerable to tears that extend into - or through - your anal muscle.

As you can guess such a tear is not a good thing. In a recent study published in JAMA - Journal of the American Medical Association - in 2008, it was stated that this type of severe trauma to your tissues increase your risks of:

pain and discomfort

prolonged healing

infection

pain with intercourse

bowel incontinence, both feces and gas

decreased sexual function

pressure for cesarean in future birth

Women have been sold on the benefits of episiotomies for decades. They were told that episiotomies had many benefits:

Note: In order for this to be true, an episiotomy would have to be done before the head distended your perineum!!

Studies concerning these claims actually suggest that routine episiotomies have little - if any - beneficial effects on neonatal outcome. In fact, the most absurd rationale of all is brain damage from fetal heads "pounding on the perineum" as suggested above...to which author Henci Goer responds:

There has never been any proof that an episiotomy protects your baby's neurologic well-being.

Moreover it has also been proven that even amongst the most vulnerable to brain damage from stress and trauma - very-low-birth-weight babies - episiotomies offer no protection. It is therefore unlikely they offer any benefits for your full term, healthy baby.

It is true that during a true emergency situation, an episiotomy is better than a c-section.

Looking all over, it is hard to find a true benefit of this "necessary" procedure performed at a rate of over 30% in the US alone. So if episiotomies lack scientific rationale, what drives their use?

Well, Robbie Davis-Floyd says:

Episiotomy Facts

As we researched, we found many studies that had been done on episiotomies, here's the jist of what we found:

Episiotomies DO NOT:

Improve healing.

Prevent pelvic floor relaxation.

Prevent lacerations.

Protect your baby.

However, all of the literature did document the following RISKS OF EPISIOTOMIES:

Extension of the incision.

Pain and discomfort.

Poor and prolonged healing

Infection - including fatal infection.

Fetal infection.

Short term / long term pain and dyspareunia - or pain during intercourse.

Considerable blood loss.

Bowel incontinence, both feces and gas

Decreased sexual function

Pressure for cesarean in future birth.

Think of it this way: things in their original state are rather strong, until they are cut - then the strength is compromised and will rip rather easily.

Ignoring this rule are obstetricians who presume that spontaneous tears do worse damage...to the contrary, studies show that deep tears are almost exclusively extensions of episiotomies!!

Note: To prove this point, take an 8 by 10 piece of paper. Place your hand on each side and pull apart. It is hard to tear right?
Now make a 1/4 inch cut on one of the long sides and once again try to tear...it tore all the way through!

Episiotomy Facts

What the Studies Found:

A physician was 2.4 times more likely to perform an episiotomy than a midwife and an episiotomy is 2 times more likely to happen in the delivery room versus a labor bed.

Note: Although mediolateral offered some protection against severe tears, studies have found that they have other problems including: increases pain, poorer cosmetic results and more dyspareunia - pain during intercourse.

And there is much more...

Serious questions are raised about the frequent use of episiotomies given the results of these studies - and in fact - it's been recommended that liberal use of episiotomies be abandoned! Perhaps attendants should be trained to do deliveries without episiotomy and learn how to protect the perineum! Or even better, leave things alone!

Reducing Your Risks

There is no guarantee, but there are certainly some things you can do to reduce the risk of tearing and to avoid the seemingly harmless procedure called episiotomy:

This is certainly not very comfortable at first - if you do it right. This will teach you to relax which is a huge help during labor. The use of oils will be a big help. For some recipes click here

When you feel the urge to push when your baby's head is "right there," take slow, deep breaths to ease her head out gently...as opposed to pushing with all your might to get your baby out fast - which may also give you skid marks and also makes you more likely to tear.

This is the "method" which will make the biggest difference.

Did you know?

...to prevent pelvic floor relaxation - sexual dissatisfaction after birth, urinary incontinence and uterine prolapse - the once popular "husbands knot" would be performed. What is it you ask?
It is an extra tightening during suturing that made your life permanently miserable!

But then again a truthful doctor admitted:

So basically here is the conclusion when it comes to an episiotomy:

The illogic of lacerating your perineum in order to protect it from laceration needs no further comment...

Apparently there are people who believe more research should still be done on the benefits of episiotomies...but considering all of the evidence against it - is it really necessary? What do they hope to prove?

Leave a comment.

Read others' comments

Episiotomy: Reviews

Any thoughts? A story of your own? Share with us!