SELF-HELP PREVENTION: EPISIOTOMY

What is it?

A cut made surgically during the later stages of labour to enlarge the birth canal and so let the baby out more easily.

There are few subjects that cause so much concern to women having babies-many episiotomies are done uncaringly and the after-effects on the woman and her sex life can be far greater than is often realized by the medical and midwifery professions.

Episiotomies are very commonly performed-in some units in the US about 90 per cent of women have one, especially for a first birth. There is evidence that they are slowly being used less.

Clearly there are medical and obstetric reasons why an episiotomy should be done but a book such as this is no place to discuss these. Usually, though, the reason the procedure is performed is that the doctors or midwives are inexperienced in delivering women without doing one and because with modern birthing positions many women are in labour in a position that makes an episiotomy more likely. Women who labour and give birth in an upright position do not have prolonged labours and rarely need an episiotomy at all because in such positions the pelvic tissues stretch slowly and evenly.

Why are they done?

• Habit-most modern midwives and obstetricians see an episiotomy as ‘normal’ and so continue to perform them.

• Impatience – many hospitals set a time limit on the length of the second stage of labour, and if the baby has not arrived by this time (usually about IV2 hours) an episiotomy is ordered to get the baby out.

• Because women who labour on their backs are actually in danger of having prolonged second stages of labour. The answer is to labour and give birth upright.

• Many obstetricians and midwives believe that tears that occur naturally as the baby is born are more difficult to repair than cuts made surgically. There is no truth in this.

• Most midwives have lost the art of ‘guarding’ the woman’s perineum to control the emergence of the baby’s head to prevent the vaginal opening from being stretched too wide, too fast-an age-old midwifery technique that worked. Many medical and paramedical people actually believe that a woman’s vaginal opening is too small and so needs surgical help during birth. Such people argue (quite without factual evidence) that a woman who has a birth without an episiotomy goes on to have a flabby vagina that is un-pleasurable to her partner and that she will eventually have more gynecological problems, such as uterine prolapse.