The Case Against Episiotomy
“I told you I didn’t want that! NO EPISIOTOMY!”My mom actually yelled those words at her doctor during my birth.On a cold January afternoon over a cup of yerba maté at the Black Sheep in Amherst, Massachusetts, she told me about the afternoon I was born.My mother scrunched her face, closed her eyes, and cried out as a powerful contraction helped move me down the birth canal. On her back with her feet in cold metal stirrups and my father by her side, she saw the doctor coming closer to her vagina with surgical scissors.“NO,” she managed to cry before another contraction consumed her concentration. “I told you I didn’t want that! NO EPISIOTOMY!”
Episiotomy: All The Rage
In the 1960s and 1970s, episiotomies were in vogue. The medical community felt it was easier to repair a straight cut in the perineum, the skin between the vagina and the anus, than a jagged tear, and that a woman would experience LESS pain after childbirth and faster healing.
It turns out the medical community was wrong.
If you read the 1,385-paged manual that obstetricians use, Williams Obstetrics (23rd Edition), you will quickly see why.Scientific studies show that episiotomy causes more postoperative pain (Larsson et al. 1991), is associated with an increase in tears in both the anal sphincter and the rectum (Angioli et al. 2000; Eason et al. 2000; Nager and Helliwell, 2001; Rodriguez et al. 2008), and more healing complications. Episiotomy also contributes to an up to sixfold greater risk of fecal incontinence (the inability to control one’s bowels) and flatus incontinence (the inability to control passing gas) (Signorello et al. 2000).“With these findings came the realization that episiotomy did not protect the perineal body and contributed to anal sphincter incontinence by increasing risk of third-and fourth-degree tears,” the authors of Williams Obstetrics write.Ouch.
Then why is this practice still in use?
Though the use of routine episiotomy is down (used in approximately 18 percent of births, according to one 2005 study), when you talk to new parents you realize that, sadly, episiotomies are still being performed too often and for the wrong reasons by American obstetricians.One mom I interviewed told me that the obstetrician on call at the hospital while she was laboring ignored a dozen pages before rushing in with wet hair wearing a tie-dye T-shirt.The obstetrician cut an episiotomy that was so long that the birthing woman’s mom (who was there helping her daughter) cringed in horror. As soon as the baby was born, the doctor rushed out again to answer another page.Two years later, she told me, things still don’t feel right “down there.”That obstetrician apparently had family visiting from out of town, which is why she wasn’t answering pages and was in such a rush. Everyone makes mistakes sometimes but this kind of impatience is inexcusable.Performing an episiotomy is not evidence-based medicine. This is an intervention that should only be used as a last resort.And what about my mom? For her fourth and final birth, her perineum stayed intact.“Okay, lady,” the doctor laughed, putting down his knife.This article was first published on Jennifer Margulis, Ph.D. and all credit is given to the original author. Jennifer Margulis, Ph.D. is an investigative journalist, book author, and Fulbright awardee. She is the author of Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family, co-author (with Paul Thomas, M.D.) of The Vaccine-Friendly Plan, and The Addiction Spectrum: A Compassionate, Holistic Approach to Recovery. Follow her on Facebook, Twitter, and Pinterest.
