episiotomy

The first birth I saw in nursing school was a memorable, wonderful experience. A mother came in to the hospital in very active labor, huffing and puffing down the halls with her husband. She was having her 6th child. There was a flurry of activity, she got admitted and received an epidural, and soon things were calm and happy. The OB was quizzing me and making me nervous. I even felt a little teary eyed when I couldn't answer his questions about which way the head was facing when he explained how the head felt during a vaginal exam. But that's beside the point.
Soon the baby was ready to be born. I cried tears of joy and wonderment at being able to witness such an amazing thing as a person being born. Everyone was happy.
Even though it was her sixth child, I do remember that the doctor cut an episiotomy. I'm guessing he did that with every birth he attended.

I was surprised to hear the other day that 2 doctors in a certain local practice that a friend was seeing have 100% episiotomy rates. I thought everyone knew that scientific literature supported limited and rare use of episiotomy. I know many doctors and midwives rarely to never cut them, so I was surprised that some still say with pride that they always cut one.

There's so much to be said on this subject. But I'll try to be quick. I had had an epiphany this week about episotomies. If you are seeing a doctor who has a high episiotomy rate, and you are adamant about not having an episiotomy, while your doctor will hopefully obey your wishes and not cut one, the doctor will still believe that the tissues will tear and an episiotomy should have been performed. It then becomes a self fulfilling prophecy. Because the doctor only knows how to do epistiomies and has little to no knowledge on ways to keep the perineum intact, there probably will be a tear. The doctor will then grumble about reparing a jagged tear instead of a nice surgical cut.

From Henci Goer: "The birth attendant's philosophy, technique, skill, and experience are the major determinants of perineal outcome."

Just insisting that your doctor not cut an episiotomy is not enough. You need to find a practitioner who has a low episiotomy rate and tries to protect the perineum. A doctor who routinely cuts doesn't believe the perineum can be protected, and therefore doesn't try to prevent a tear.

Yes, even with a good practitioner a woman can still tear. But there's much to be desired in having a practitioner who at least believes that birth can happen without a cut or a tear.