Monday, February 4, 2013

Mama Monday - Episiotomies

I've said it before, and I'll say it again: you have choices in childbirth. The first step in knowing your choices and making them known to your care provider is being educated. I am passionate about women knowing their choices in childbirth, which is why I write about them on my blog and why I have developed a detailed Birth Plan Manual for my clients to assist and empower them in the process. 

One of the most feared interventions in childbirth is the episiotomy, and it is one reason many women consider elective cesarean births. Who wouldn't want to avoid an aggressive and painful procedure performed on one of the most vulnerable and sensitive body parts? But what so many women don't know is that this procedure is completely avoidable, unlike many of the harsh consequences guaranteed to accompany a surgical birth.

What Is an Episiotomy?

Episiotomies are cuts made to the perineum (the small, sensitive area of tissue located between the wall of the vagina and the opening of the anus) by the obstetrician, family doctor or midwife during the second stage of labor. The purpose is to widen the vaginal opening to make room for the crowning baby. Especially in first time labors, the vaginal and perineal tissue is very tight since it has never been stretched to this extent. It can sometimes take a long time, possibly hours, for this tissue to stretch enough to make way for the baby to emerge into the world.

What You Need To Know:
Some practitioners consider this a routine intervention, performing episiotomies on all birthing women, whether they believe it is always necessary, or because it speeds up the birth process. Your caregiver may feel an episiotomy is necessary if the baby is already in the birth canal, crowning, and in distress of some kind. Your caregiver may perform an episiotomy to birth your baby quickly and save his life. However, many skilled and knowledgeable midwifes will tell you they have never seen a need for an episiotomy.

If you are already tearing, or beginning to tear toward your urethra and clitoris, instead of toward your perineum and anus, your caregiver may perform an episiotomy to prevent such a tear. Tearing in the direction of your urethra and clitoris is extremely painful to recover from, and can cause serious complications far into the future. 

Episiotomies are generally considered more painful to recover from and take longer to heal than a natural tear would. If you would prefer a small, natural tear to an episiotomy, it is important you make this clear to your caregiver. 

How to Avoid an Unnecessary Episiotomy:

Tears and episiotomies can both be prevented with prenatal exercises such as Kegel exercises and perineal massage. During birth, warm compresses and more perineal stretching performed by your caregiver can also help prevent episiotomies and lessen the possibility or severity of tears. Often, a simple change in pushing position for the second stage of labor can avoid what some practitioners may feel is a necessary episiotomy. 

One of the greatest choices you can make to avoid an episiotomy is avoiding epidural analgesia. Since pain relief in the form of an epidural partially and sometimes completely numbs everything from the waist down, many women have a very hard time feeling the Ferguson Reflex (urge to push), and have difficulty pushing effectively. If you are able to work with your body and feel how to push correctly, as well as have the wherewithal to assume advantageous positions, your caregiver will feel less inclination to "help you out" with that unhappy little snip!

In short, there is no good evidence to support routine episiotomy on every woman, regardless of medical indication. When constructing your birth plan, be sure to include your preferences regarding routine episiotomies.

At Honeybee Mama, I'm committed to getting you the tools and resources you need to make informed decisions about your birth. If you have questions about your options in childbirth, check out my childbirth training manual and The Birth Experience Childbirth Training, or schedule a consultation today!

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