Episiotomy Epidemic

Episiotomy is an epidemic surgery. It’s usually not helpful, and hardly ever necessary. In fact, research proves it is harmful.

What is Episiotomy?

Episiotomy is a surgical cut across the perineum. It’s performed during childbirth to widen the vaginal opening and to prevent tearing. There’s a wide range of claims about the benefits of episiotomy, but these claims are unfounded.

“Medical science knows that routine episiotomy has no benefits and carries many serious disadvantages.”

“…a woman can give birth intact, uninjured, and unafraid.“

The above quotes are from Ina May’s Guide to Childbirth; in the chapter Forgotten Vaginal Powers and Episiotomy.

There are two types of episiotomy: the midline and the mediolateral. 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 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.  Reality:  it often makes tears worse. Here’s an interesting analogy to 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.

Having the soft tissues of your pelvic floor cut weakens them and make a tear even more likely. Women who have third and fourth degrees tears often have a first or second degree episiotomy.

Avoiding Episiotomy

In rare instances episiotomy is a wise choice. Ina May Gaskin reports it may be wise when a breech baby boy is coming with testicles presenting first, or when the coming baby is in real distress. Otherwise episiotomy is usually not necessary. It’s a mindless routine that harms women.

You can avoid episiotomy:

• Choose a doctor or midwife with a low episiotomy rate
• Understand your body and prep your pelvic floor
• Only push during labor when you feel the urge; Mother-Directed pushing
• Slow down during crowning (even pushing your baby’s head out between contractions)
• Use low, loose-jaw vocalization (moaning) during birthing

First, 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. Learn concrete strategies for increasing the tone and flexibility of your pelvic floor.

Only push when you have the urge to during labor. Tell any “cheerleaders” instructing you to push non-stop to be quiet! You need to listen to your body and not another person. This lets your baby descend gradually. Your tissues have time to warm up and expand around your baby.

Slow down during crowning. Push slowly and let your baby’s head crown and birth gently. You can ask your care provider to place warm compresses against your perineum (the soft tissues between your vagina and anus.) Feel free to place your own hands over your pelvic floor to support your body. This is especially effective in helping you to relax and open up.

Be vocal during labor and birth. Keep your mouth relaxed and open, which helps relax and open your bottom. Make low vocalizations. Moan, don’t scream. This keeps you open and relaxed, and also give you relief from tension. It really works. Practice during pregnancy 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) your body needs time to heal. This is true even if you give birth without a cut or tear. But an episiotomy can cause long-lasting pain.

The incision generally heals within 10-14 days. The stitches are usually the kind that are absorbed into your skin. It’s not unusual for pain to last longer than just the time it takes you to “heal.”

Healing Ideas:

• Use herbal sitz baths
• Use ice packs / frozen postpartum pads
• Use a peri-bottle
• Eat plenty of nutrient-dense foods
• Kegel as soon as you’re able to
• Heal emotionally
• Give yourself time to heal

You can use sitz baths for healing almost immediately. An herbal sitz bath soothes your bottom and provide healing to wounded tissues (even if you haven’t torn or had an episiotomy).

Purchase a pre-made sitz bath solution from a birth supply shop or 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.

Let the herbs steep for a little while. Many midwives recommend adding non-iodized sea salt to the mixture. Run a bath that comes to your hips and pour the mixture in. Soak for a little and enjoy. Do a couple of sitz baths a day for the first several days after birth. It’s okay to bring your baby into the bath with you too 🙂

Ice packs also soothe your sore perineum. Don’t keep an ice pack on too long and take breaks from them. The cooling action can help with swelling and bring relief from pain.  You can also soak a few postpartum pads and put those in the freezer to provide cooling relief – using one first thing in the morning helps with swelling and soreness that developed overnight.

Have lots of good, nutrient dense food to enjoy as you and your baby get to know each other. Eating well means your body can heal and rebuild as it needs to.

Use a peri-bottle. You’ll get one of these at the hospital/birth center or it’ll come with your home birth kit. Use it! Fill it with warm, clean water. Use the water to wash your sensitive bottom area after urinating.  You can also use it while peeing if you’re feeling any stinging or burning (tell your nurse or midwife if you do).

Pat dry after using a peri-bottle. This is much, much gentler than wiping. Use the peri-bottle for as long as you need to.

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.

You may have a lot of hard feelings about your episiotomy. You may feel violated. You may feel frustrated months later when your scar still causes pain during lovemaking. These feelings are normal.  Gently working with the tissues and muscles of your perineum over time can help loosen adhesions and bring more comfort.

Related Articles

• Comfort During Labor – a series on comfort in labor and managing the pushing stage gently
• Relaxation for labor and birth
• Inspiring Natural Birth Stories – grouped by home, hospital, etc.!

Steven Depolo