More women should ask this question when an episiotomy is suggested! What is an episiotomy? It's a cut in the perineum (the flat area between the vagina and anus). Why would anyone get cut down there?! Where did the idea to cut in such a sensitive area come from? Interestingly enough from doctors way back when, in the 1920's era of twilight sleep births. Women were completely knocked out and had no consciousness or awareness of what was going on. When it came time to push, obviously they were incapable. So the doctor had to go inside and pull the baby out...usually via forceps. With the addition of forceps the doctor needed more room, enter episiotomies. Women are conscious and aware during labor these days...that's arguable if you have an epidural. But clearly women are not knocked out like they were, so why still use an episiotomy? Good question!
One reason given is to help prevent a tear down there. There are 3 different cuts used however, the most common is called a midline. It's a cut from the vagina straight down. This is the worst kind yet easiest to perform and stitch up, so of course it's used most often. Why is this the worst? Think of a piece of cloth. If you grab it and try to tear it apart, it's very difficult perhaps impossible. Now if you start with a little cut already in place, you can tear right through it. That is your perineum. With no cut in place, tearing should be minimal or not happen at all. But with a cut, you may rip right through to your anus. OWWW!!! Because this was such an issue 2 other options came about. The mediolateral: instead of going straight down from the vagina it's a diagonal to the side. The 3rd kind combines the two and looks like a hockey stick: straight down from the vagina and then to the side.
These cuts are done during crowing where the pressure of the babies head is pushing against the perineum and creates a natural anesthetic. After the birth, you can feel it and you need a local anesthetic to stitch it up. If you were to tear naturally, it would be a much smaller tear and most likely will not need stitches. There are ways to avoid an episiotomy and most likely a tear. During pregnancy: do squats. Instead of bending over, squat. This helps stretch the perineum and prepare you for labor. During labor: only push when you feel the urge. Pushing at any other time creates pressure on your perineum when it's not ready to stretch. Take your time pushing the babies head out. Allow your perineum to stretch naturally and don't force it to open before it's ready. Your body prepares for this by pushing baby down during a contraction and then receding a bit. It doesn't mean your baby doesn't fit or doesn't want to come out...this is the natural process your body is going through in order to protect itself from injury. Work with your body, not against it...it really does know what it's doing. This coming down and receding of baby is especially important if you have a large baby. Your baby is built to fit through your body...but again, we must let our bodies do the work it knows it needs to do. Kegels also help strengthen your perineum. They are important both before and after baby! Warm compress, perineum oil or olive oil, and perineum massage during crowning help relax and stretch the perineum so that it will not tear.
Other reasons given:
-it helps speed up your labor. It does but a few minutes cut from labor doesn't replace weeks and months and perhaps a lifetime of pain and discomfort.
-protects against incontinence. The episiotomy may actually cause incontinence. Kegels will strengthen you down there to protect you against this.
-protects baby from shoulder dystocia. There are actually different laboring positions that can help a baby who is stuck.
The fact is every reason given has been given without any proven medical research. Most women do not need it. Medical science knows that routine episiotomies are not beneficial and carry many disadvantages. For example: pain and discomfort for weeks and months perhaps a lifetime, sexual dysfunction due to the pain, increase blood loss, create a larger tear than necessary, cause incontinence, cause you not to be able to breastfeed because of the pain. If medical science knows there are no benefits why do some doctors continue to do it routinely? It's how it's always been done...they learned this in their training and continue to do it. Regardless of true need and lack of medical evidence.
Be sure to ask your doctor their view on episiotomies. Some think most first time moms need it. Other think all women need it. Others think it should only be saved for absolute need. A good response is NOT: we'll see what happens during labor. That generally means you will end up with one.
This little cut is a very big deal! Please read up on it and know where your doctor stands.
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