Episiotomy...Why? For those of you who don't really know the correct definition, an episiotomy is the cut performed on a woman's perineum (the tissue between the vagina and the anus) to allow the baby's head to emerge more quickly during pushing. If you know your anatomy, you also know that a baby whose head is already pushing on the mother's soft tissues on the perineum, has cleared the bony pelvic passage, and is thus minutes away from being born.
So why are women cut? To put it simply, it is at the attendants discretion, this can be an OBGYN, doctor, trainee doctor or even midwives. Some attendants prefer to cut and believe it is for the best, others refuse to cut unless it is absolutely necessary (I agree with the latter). There are times when an episiotomy is necessary, for example, when a baby's shoulders are stuck and more room is needed to maneuver the baby out. Also if the perineum is just too tight and the head won't emerge and the baby is compromised then an episiotomy may be needed. More often than not, this situation will fix itself with a position change. For example from back to front or to kneeling or standing. Usually a woman will tear to allow the baby to emerge, this is the much more gentle option and will heal much quicker than a surgical cut. Usually a small tear will heal on its own as it will fit together neatly, no stitches needed.
SEVERS
According to the WHO (World Health Organization), there is no need to routinely administer this cut, which severs skin, nerves and muscles in this sensitive area, and is the equivalent to a third-degree tear. The prevalence of third-degree tears in home births or birth centers with minimalized medical intervention is 0.3%. That's 3 women in 1000. By contrast, in Hungary, 70% of first-time mothers receive this cut. The rationale: to prevent fourth-degree tears despite the fact that scientific studies have shown that routine administration of an episiotomy actually increases, rather than decreases, the incidence of fourth-degree tears. If you can picture this, a women is pushing her baby out and the doctor puts a little cut in her perineum to aid in the quick arrival of her baby. Now, once a cut is performed, the skin has a weak point and as the baby rushes passed this cut, a bigger tear can follow on down the line of the small cut leading to a larger tear. Therefore, the woman has been surgically cut and then tore resulting in a much larger tear. This area will then need extensive stitching and time to heal, not to mention the risk of infection.
So why does a woman receive an episiotomy? Well I will list the reasons so it is easy for you memorize and avoid:
* The baby's heartbeat is uneven, or too low at this stage, which is totally normal.
* If a woman is lying on her back whilst pushing this will reduce the diameter of her pelvis by approximately 28%, creating a smaller outlet for her baby and adding to the uneven heartbeat.
* If the woman is trying to push against gravity, ie, on her back, pushing uphill. The shape of a woman's pelvis is curved up at the opening of the vagina, thus, lying on her back will create a steep exit for the baby and longer time for the head to be sitting on the perineum. Most doctors have a time limit in their head and will cut if this time has expired!! Ridiculous!
To recap, lying on your back, pushing up hill and reducing the size of your pelvis will all contribute to your chance of an episiotomy. So what can you do? Here is a list of dos:
* Labor in an upright position to widen your pelvic outlet, this also allows your baby to descend at its own speed. Your tissues will have had an opportunity to adjust to the pressure of the baby's head if you are in control.
* Feel when your tissues stretch and pause to give them a chance to adjust and accommodate the size of your baby's head.
So ladies, get to know your perineum, use a hand mirror and have a look at this area, touch and feel it. It is meant to stretch and it is a fantastic, elastic part of childbirth. Don't fear the perineum, imagine it stretching and imagine the warmth flowing through your body as it allows your baby to emerge out of you and into your arms. WOW, got to love your peri (midwife talk for perineum)!
If you have a look at my book link you will see that I have interviewed some great, world acclaimed natural birth experts. They have very strong views on episiotomies and voice them with great passion. You just have to hear what they say, it is amazing. Just imagine being armed with all this information before you go into labor.......you will be strides ahead of the rest.
Good luck with your natural birth and please contact me if you have any questions.
Episiotomy - WHY? SEVERS
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