You’re Going To Cut WHAT: All About Episiotomies
*Disclaimer: I am not a medical professional, I am not giving medical advice. I am stating my opinions and encourage everyone to do their own research before making any medical choices*
Many of us have probably already learned somehow what an episiotomy is (and have been horrified by it), but let's recap so we're all on the same page.
An episiotomy is when, during birth, doctors (and even some midwives) cut a line down through the perineum from the vagina towards the anus, with scissors. Fun right? Not.
The reasoning behind this is that some believe it's better to be cut in a clean, straight line than to tear naturally. It's "supposed" to protect the pelvic floor muscles, which will prevent urinary incontinence, vaginal or uterine prolapse, and sexual dysfunction.
This is not true.
Many older women who have these problems now are from a time when it was much more common place to perform episiotomies. Thankfully, rates are dropping, but they are still prevalent in our medical system today.
A lot of it stems from some doctors not trusting women's bodies to do what they are meant to do. They want to intervene. They want to make things go faster.
How to tell if your care provider doesn't trust your body:
-They give drugs (like pitocin) to speed up your body's own natural labour process
-They put birthing women into positions unnatural and uncomfortable (most of the time)
-They make you push in a non-upright position that spreads your legs so far apart that your perineum has no where to go and will tear
-They tell you how to breathe and push when you are dilated to 10cm, even if you don't feel the urge or feel like you aren't breathing properly
When you tear, there are four classifications to determine how badly you've torn:
First-Degree : injuries to skin and connective tissue
Second-Degree : injuries to underlying perineal muscle
Third-Degree : injuries go into, but not through anal sphincter
Fourth-Degree : injuries go completely through the anal sphincter
Episiotomies make second-degree wounds.
Medical Indications for Episiotomy:
-Fetal Distress - Rather than waiting for a few more contractions, they will perform an episiotomy to get baby out right away (sometimes though, baby is in distress because he doesn't have enough oxygen, so be sure to breathe in a way that feels right and comfortable!)
-Shoulder Dystocia - This happens when the head is born but the shoulders are stuck behind the pubic bone. I don't see how episiotomies help this as it is not a soft-tissue issue, but it is an emergency so you can't really argue with medical staff. (There are maneuvers to help this though)
-Instrumental Delivery - Cutting the perineum will give your doctor more room to maneuver the instruments, but there is more increase in deep perineal tears
-Inelastic Perineum - This is a judgment call decided by your healthcare provider. You have a better chance of avoiding an episiotomy if your doctor has lower rates of doing them
How To Protect The Perineum:
-Choose a caregiver who has a lower episiotomy rate
-If your care provider does it routinely (not as an emergency) you can refuse it, put it in your birth plan, and tell them!
-Kegels! They make your pelvic floor stronger and more elastic
-Exercise, because the stronger you are the less chance of tearing and you'll recover quicker
-Perineum Massage. While you're pregnant, you or your partner massages your perineum once a day for 5-10 minutes (with clean hands!) using olive oil, massaging in a 'U' shape, slightly stretching the skin until there's a small burning sensation. Greatly reduces risk of tearing
-Avoid epidural as it will be harder to feel the sensation to push
-Use your natural urges and try to breathe rather than push baby out
-Birth upright, or at least without legs stretched super wide apart
-Apply warm compresses to perineum as baby is crowning
An amazing book that covers this (and so many other medical procedures) is Henci Goer's "The Thinking Woman's Guide to a Better Birth". Plenty of comprehensive information as well as studies and literature on procedures. Highly recommend.
What it comes down to is that this is your birth, and you get to do it however you like. (Though emergencies can happen, in which case whatever must be done for the health of baby and mama.)
If you feel strongly against having an episiotomy, ask your care provider what their rates of them are, and go from there. If they're all gung-ho for them and you don't feel comfortable, it's never too late to switch.
You deserve to have your wishes (and your perineum) respected.