An Episiotomy is a surgical cut intended to widen the vaginal opening. The two most common types of episiotomies are midline (toward the anus) or medio-lateral (diagonal, away from the anus). This procedure was originally intended to prevent severe tears and trauma to the perineum during a vaginal birth or to expedite a birth in the case of fetal trauma, or to allow an instrumental (forceps or vacuum) delivery. This practice originated in the 18th century 😱 and it was thought that a surgical cut was better than a natural tear, and that it reduced the chances of incontinence (leaking urine and/or feces) and improved sexual function. What does research today tell us about episiotomies? 🤔 Should they be routine? 🤔 What are the risks? 🤔 Is there ever a time when it’s beneficial? 🤔
📌The World Health Organization recommends episiotomy rates of below 10%.
📌A study done in 1983 showed that episiotomies did NOT improve incontinence or sexual function, but that it actually INCREASED the odds of a woman experiencing BOTH.
📌Episiotomies effect the mother more than the baby
📌It can lead to a traumatic birth experience
📌It can impact mothers quality of life
➖chance of infection
📌They do not reduce the risk of severe vaginal tearing but rather INCREASE your chances of tearing further. How? Imagine making a little cut into a piece of fabric. It makes it easier to rip the fabric by just making that initial cut! Same thing with the perineum.
📌Surgeons are accustomed to sewing back together clean, straight cuts made by scalpels. Not a rugged irregular cut. A natural tear follows the lines of tissues which can be sewn back together like a jigsaw puzzle. An episiotomy ignores anatomical structures and borders and disrupts the integrity of muscles, blood vessels, nerves, and other tissues. This is what causes more bleeding, more pain, more incontinence, loss of muscle tone, and discomfort during intercourse.
✂️Episiotomies should NEVER be used as routine practice, but rather only be used in the rare occurrence of when it’s appropriate, like if your baby's heart rate drops and the birth is expedited by cutting the perineum, if the baby is being delivered by forceps or vacuum suction(episiotomies are not always needed for this either), or if babys's shoulders are too wide to fit through the birth canal and nothing has worked to free the shoulders✂️
What are preventative measures you can take to reduce tearing🤔
🌸do exercises such as Kegels and squats
🌸perineal massage starting at 34 weeks, 3-4 times a week:
➖wash your hands and trim fingernails
➖use almond oil, coconut oil or vitamin e oil
➖take a warm bath or use warm compress to soften the area
➖lay comfortably and relax
➖apply oil to perineum
➖Insert your one or two thumbs about an inch into your vagina (about to your thumb’s knuckle), and put firm but gentle pressure straight down on the perineum. Allow the perineum to stretch for a minute or two. After it stretches for a few minutes, you may be able to get the second thumb in more easily. Slight burning or stretching is OK, but if you experience pain, use more gentle pressure, or stop the massage. Once the perineum has been stretched for a couple of minutes, gently move your thumb up along the sides of the vagina, stretching it from side to side.
🌸during birth, squatting or side-lying positions during pushing, “breathing down” the baby during crowning for a slow emergence, instead of forced purple pushing as well as the use of hot compresses on the perineum, and mother-led pushing, have been shown to reduce the chances of tearing and episiotomy.
🌸an unmedicated birth can reduce perineal trauma since the birther will follow her natural cues to push with the cues from her baby as well.
💚The American College of Obstetrics and Gynecology (ACOG) changed its stance concerning the procedure, encouraging its members to take more preventative measures, and avoid episiotomy whenever possible💚
ACOG AND OTHER ORGANIZATIONS HAVE RECOMMENDED AGAINST ROUTINE EPISIOTOMIES YET WE STILL HAVE PROVIDERS WHO USE IT AS COMMON PRACTICE DURING BIRTH. YOU HAVE THE RIGHT TO REFUSE AN EPISIOTOMY AND SHOULD CONSIDER TALKING ABOUT THIS WITH YOUR PROVIDER BEFORE GIVING BIRTH!
EPISIOTOMIES THAT ARE DONE WITHOUT THE BIRTHERS CONSENT IS TRAUMATIC AND IS ALSO OBSTETRICAL VIOLENCE!
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