2023 Author: Anita Thornton | [email protected]. Last modified: 2023-08-25 11:16
For the past ten years, episiotomies have had a bad press. Motherforlife presents different aspects of this small cut with large effects.
What is an episiotomy?
An episiotomy is a surgical incision, made by a doctor, in the skin and muscles of the perineum (between the anus and the vagina) that would prevent or reduce spontaneous tearing.
When do we practice?
The doctor makes the incision at the moment of expulsion. Episiotomy is performed when the vaginal opening is too narrow or in certain other cases such as breech presentation, shoulder dystocia, a "at risk" perineum (fragile, scarred or short) or a "fragile" fetus (premature, fetal distress). Episiotomy reduces expulsion time and would prevent deep tears.
The Quebec Public He alth Association reports that in Quebec, in 2000-2001, episiotomies were performed on average in 30.1% of vaginal deliveries. This is still an evolution, because the rate was 70% 15 years ago.
“Episiotomy is still often presented as a necessary act, while many scientific studies show the opposite. TheThe reasons cited to justify episiotomy are primarily the acceleration of fetal expulsion and the use of instruments such as suction cups or forceps. Secondly, the argument is to avoid a tear, supposedly potentially more important than the voluntary cut. However, episiotomy is classified by the World He alth Organization in "practices frequently used wrongly" during normal childbirth", reports the Association for Public He alth of Quebec in its review Périscoop in April 2004.
Since 1983, studies have called into question the benefits of systematic or so-called routine episiotomies. Recent research clearly indicates that episiotomy should no longer be routine. Indeed, the National College of French Gynecologists and Obstetricians believes that episiotomy has more disadvantages than advantages.
More risks than benefits?
“It is often said that an episiotomy is the most sensitive cut there is. The procedure consists of cutting the skin and muscles of the perineum, the part located between the vagina and the anus of the woman during childbirth. It was previously believed that this procedure was less painful and damaging than letting the tissues tear naturally. It was also thought to prevent urinary incontinence later. Over the past two decades, many compelling scientific data have contradicted this view,” writes the Ottawa He alth Research Institute (OHRI).on the thorny issue of episiotomy.
A study by two Canadian researchers in the scientific journal Obstetrics and Gynecology agrees. The work of two researchers, Érica Eason and Perle Feldman, shows that babies born without an episiotomy are doing just as well as the others and that their mothers would preserve stronger pelvic muscles when their perineum was allowed to stretch naturally during childbirth.. "This procedure, which is still often routine in North America, would in fact be of particular benefit…to the doctor, for whom it saves precious time", noted in the Gazette des Femmes for the months of May-June 2001.
All over the world, doctors are therefore invited to rethink their practice of episiotomy, which many women consider to be one of the excesses of the overmedicalization of births. The fact remains that, despite the recommendations asking to restrict its use of episiotomies, a study carried out in Ottawa, in 2005, concludes that they remain frequent. “In Canada, the national rate is 24% for episiotomy, varying between 3% in Nunavut and 31% in Quebec,” notes the IRSO.
If the cut does not really cause pain, since the doctor makes the incision in already very tense muscles and the pressure of the baby's head on the tissues causes physiological anesthesia, the consequences of the episiotomy are often more painful. It is necessary to sew, under local anesthesia, the cut skin with an absorbable thread (melting). Unpleasant operation, of course. In addition, the hours following the procedure, the affected area is painful and sensitive. Both walking and sitting can be inconvenient. There is a risk of hemorrhaging, healing may be slow and pain may persist.
“Women who undergo an episiotomy tend to have more tissue tearing, more pain, more stitches and a longer recovery after birth,” says Dr. Walker, obstetrician at The Hospital of Ottawa and scientist at the IRSO. While episiotomy can hasten childbirth, it should only be used if it is obstetrically necessary, that is, when the he alth of the mother or child is at risk. »
For or against?
A study carried out by researchers from the Faculty of Medicine at Laval University in 1994 shows that midline episiotomy increases the risk of severe tearing of the perineum threefold. In addition, the World He alth Organization recommends not to exceed a rate of 10% of episiotomies.
“For more than 20 years, medical studies, which have been carried out in abundance, show that no situation requires an episiotomy; whether in the case of forceps, dystocia or other, episiotomy is only essential on a case-by-case basis, after having tried everything to avoid it and carefully evaluating the situation”, underlines the site www.episiotomy.info
In May 2005, the famous Journal of the American Medical Associationreveals that episiotomy usually offers no benefit, according to a systematic review of studies to date. More so, researchers have found that episiotomy often does more harm than good to mothers. According to the analysis of routine deliveries reviewed, however, women who did not undergo episiotomy had less pain, recovered more quickly from childbirth, and had no increased or decreased risk of complications with respect to wound healing. Additionally, the data revealed that episiotomy offered no protection against urinary or fecal incontinence or pelvic prolapse in the first three months through the fifth year postpartum,” noted the Women in he alth. The researchers of the JAMA study even came to the conclusion that the data collected did not confirm the benefits that are traditionally attributed to episiotomy.
“Episiotomy is one of those practices that has become routine based on a lot of theory and scant evidence that it is beneficial,” says Dr. Graham, associate professor at the School of Nursing and Epidemiology and Department of Community Medicine at the University of Ottawa in their study published by OHRI. A few decades later, studies are multiplying to show that in reality, this practice is not beneficial and even, in some cases, that it can be harmful. Yet this intervention continues to be carried out freelyin many countries around the world. This is a clear example that some he alth professionals do not keep abreast of scientific literature. Women should talk to their caregivers about this. »
Could episiotomy be avoided?
Yes! But let's be realistic: it is better to discuss our fears and desires with our doctor during monthly pregnancy monitoring appointments. Once in the delivery room, the time is not conducive to heated discussions. This way, you will be able to clearly state your position to your specialist. Note that an episiotomy in a first delivery does not mean a similar scenario for the others that will follow.
Are there alternatives?
With good perineal musculature, the chances of avoiding an episiotomy are increased. Try to promote the elasticity of the muscles of the perineum by doing a few exercises:
- Stand up, your hands embrace your lower abdomen; the body is supple and straight. Contract and relax the perineum and gluteal muscles.
- Seated, knees slightly apart, feet together. Place your hands on the inside of each of your knees. Contract the perineum and, at the same time, try to bring your knees together as your hands push them apart. Practice this exercise while exhaling.
- During childbirth, during the expulsion phase, the muscles must be given the chance to distend. Massage, hot water compresses or pressure on the perineum are welcome!
Care needed after an episiotomy
Good vulvar hygiene will facilitate the healing and disappearance of melting points. Make sure the perineal area is clean and dry.
- Vulvar toilet three times a day and after each bowel movement.
- Using mild soap and a clean, wet washcloth, wash the perineum in a front-to-back motion.
- Then rinse with lukewarm water before patting dry.
To lessen the pain
- The hospital usually gives you lidocaine (or other) cream to apply to the spots 3 to 4 times a day.
- A sitz bath can relieve you.
- Change position often, avoid standing too long.
Not so long ago, episiotomy was performed almost systematically, at all deliveries. What should we know about this declining practice?