Natural Birth and Baby Care.com

Episiotomy Epidemic

"...a woman can give birth intact, uninjured, and unafraid."

The above quote is from Ina May's Guide to Childbirth.

The chapter that contains it is named Forgotten Vaginal Powers and Episiotomy.

It gives a critical look at the surgical procedure of cutting a woman's pelvic floor tissues open.

It also gives a refreshing and down-to-earth look at just how amazing women and their stretchable tissues are.

Ina May's Guide addresses an issue that has become so accepted it is alarming. Episiotomy is an epidemic surgery. Like most "birth interventions" it is not usually helpful and it certainly hardly ever necessary. In fact, episiotomy is being proven to be harmful.

What is Episiotomy?

Episiotomy is a surgical cut across the perineum. It is performed during birth to widen the vaginal opening and to prevent tearing. Doctors have made a wide range of claims about the benefits of episiotomy, but these claims are in fact unfounded.

"Medical science knows that routine episiotomy has no benefits and carries many serious disadvantages." Ina May's Guide to Childbirth.

There are two types of episiotomy: the midline episiotomy and the mediolateral episiotomy. A midline cut is straight down from the vagina to the anus. A mediolateral cut angles off from the vagina to one side. Both types of episiotomy are measured in degrees from one to four. A first degree episiotomy is a small snip. A fourth degree goes all the way from the vagina to the anus.

Many doctors claim that episiotomy prevents tears. However it often makes them worse. I have heard an interesting analogy that I think will help you understand this principle:

If you have a piece of cloth and try and tear it in two it requires quite a bit of effort to tear it straight down the middle.

Now take the same piece of cloth and imagine putting a small cut in it with a pair of scissors. Now, starting at that cut try to tear the cloth. It is much, much easier.

Episiotomy is much like this. Having the soft tissues of your pelvic floor cut by your doctor will weaken them and make a tear even more likely. Women who have third and fourth degrees tears have often had a first or second degree episiotomy.

Avoiding Episiotomy

There are very rare instances that an episiotomy is a wise choice. Ina May says that some times it may be wise are when a breech baby boy is about to be born with testicles presenting first, or when the coming baby is in real distress. Other than this episiotomy is not necessary. It is a mindless routine that harms women.

There are ways you can avoid episiotomy. One important way is to carefully consider your care provider. Choose a doctor or midwife who has a very low episiotomy rate. Make sure that your care provider is familiar with and respects all the recent research that proves routine episiotomy hurts women.

Take the time to learn about your body during pregnancy. Informing yourself and truly understanding just how your body is designed to give birth without being cut is empowering to you. Take the time to learn concrete strategies for increasing the tone and flexibility of your pelvic floor.

I highly recommend you start by reading Ina May's Guide to Childbirth (no surprise there, right?) Then you should find a childbirth class that acknowledges the power of your body.

The Pink Kit will give you an excellent look into what your body can do and how you can work with it during labor - no matter where and how you give birth.

During labor you should only push when you have the urge. Tell any "cheerleaders" urging you to push non-stop to be quiet. You need to listen to your body and not another person. This will allow your baby to descend gradually as he or she should. Your tissues will have time to warm up and expand around your emerging child.

Slow down during crowning. Push slowly and allow your baby's head to be born gently. You can ask your care provider to place warm compresses against your perineum (the soft tissues between your vagina and anus.) You can also feel free to place your own hands over your pelvic floor to support your body. This may be especially effective in helping you to relax and open up.

Being vocal during labor and birth is helpful. Keep your mouth relaxed and open, which will help relax and open your bottom. Make low vocalizations. Moan, don't scream. This well help keep you open and relaxed, and also give you relief from tension. It really works. Practice during pregnancy if you need to. And just let go when you give birth - don't let hospital staff tell you to be quiet.

Healing from Episiotomy

If you had an episiotomy or tear (or both) then your body will need time to heal. This is true even if you give birth without a cut or tear. But an episiotomy can cause long-lasting pain.

Normally the incision will heal within 10-14 days. The stitches are most of the kind that are absorbed into your skin. However, it is not unusual for pain to last longer than just the time it takes you to "heal."

Something you can do almost immediately is to enjoy sitz baths. This is a good idea even if you have no tearing or episiotomy. An herbal sitz bath will sooth your bottom and provide healing to wounded tissues.

You can purchase a pre-made sitz bath solution from a birth supply shop or you can make your own before birth. Simply add a generous handful of the following herbs to a pot of water that has been brought to a boil and removed from the heat: lavender, comfrey leaves, sage leaves, calendula, and rosemary.

Allow the herbs to steep for a little while. Having a Baby, Naturally recommends adding non-iodized sea salt to the mixture. Run a bath that will come about to your hips and pour the mixture in. Soak for a little and enjoy. You can do a couple of sitz baths a day for the first several days after birth. It is ok to bring your baby into the bath with you too, if you'd like.

Another thing you can do in the immediate postpartum period is to place ice packs on your sore perineum. Don't keep an ice pack on too long and do take breaks from them. The cooling action can help with swelling and bring relief from pain.

Be sure that you have lots of good, nutrient dense food to enjoy as you and your baby get to know each other. Eating well will ensure that your body can heal and rebuild as it needs to.

Use a peri-bottle. You will be given one of these at the hospital/birth center or it will come with your home birth kit. Use it! Fill it with warm, clean water. After you urinate use the water to wash your sensitive bottom area.

Then pat dry, if you like. This is much, much more gentle on you than wiping. You'll probably enjoy using the peri-bottle for the first couple of weeks postpartum.

Begin Kegels as soon as you can. It may be hard at first, but these exercises strengthen your pelvic floor. They help bring blood to your tissues for healing and re-growth.

Emotionally you may have a lot of hard feelings about your episiotomy. Realizing that most are done for no reason is especially rough. Be sure to talk over your concerns and feelings with someone you trust.

You may feel violated. You may feel frustrated months later when your scar still causes pain during lovemaking. A caring midwife may be able to help you sort through your feelings as well as give you advice on easing lasting pain.