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Episiotomy

Posted Jul 21 2010 12:00am

When I was younger I remember hearing the word episiotomy in relation to childbirth but never really knew what it meant.  As I got older, I heard the word less and less often.  That is until my senior year of college when I got to know the meaning of the word quite well without actually experiencing it myself.  In one of my seminar classes, a classmate (a midwife by day) was telling the class about the term paper she was writing.  It was about the birthing practices of rural Nicaragua.  She worked in a tandem network of midwives both here in the US and in Nicaragua.  She said that the practice of episiotomy in the US was almost completely extinct but that it was still commonly used in Latin America.

In a class of about 11 women and 1 man (poor guy!), we all wanted to know more about this “episiotomy.”  So, in the spirit of that midwife taking her time to explain this practice I hope to impart a better understanding of the practice on you.

I have heard an episiotomy rather brutally and frankly described as cutting the vagina to make it wider for a baby’s head to pass through more easily during birth.  This is basically true but is not necessarily as barbaric as it may sound.  The cut is actually a type of surgery and it is done under anesthesia.

Most Western countries (United States, Australia, and Europe in particular) have moved increasingly away from using the episiotom y because of the complications it can cause.  A birth may progress without any need for the vaginal opening to be wider or the perineum (skin at the back of the vagina) may tear on its own.  This, too, is not as gruesome as it may sound.  A natural “tear” is often much shallower than an episiotomy.  Thus an episiotomy may take longer to heal and cause more complications.

There are two main types of episiotomies:  one is basically a straight, lateral cut from the vagina backward–this is called midline.  The other kind is is called medio-lateral and is cut at more of an angle away from the anus.

While there is certainly a time and a place for an episiotomy (as there is for a Cesarean section), I believe that natural tearing is preferable to episiotomy if possible.  The midwife I mentioned earlier explained this in an example I will never forget.  She took a piece of notebook paper and cut it halfway through with scissors.  ”This is an episiotomy,” she said.  She took another piece of paper and tore it half way.  She said, “This is a natural tear.”  The torn piece of paper had all sorts of fibers and extra edges to it that the cut piece of paper didn’t have.  These overlapping bits provide a better opportunity to heal.  (Imagine trying to glue the cut piece of paper back–you couldn’t!  But you could with the torn piece of paper.)

Some studies show episiotomies, especially midline, cause greater complications even after the healing has occurred.  For instance, a woman can have trouble with sexual intercourse–it can be painful due to scarring and her vaginal walls can have trouble becoming lubricated.

There are certain therapies (such as massage and perineal dilation ) than can help give the vagina preparation for birth that will make it less likely that a doctor will perform an episiotomy.  In any event, it is yet another complicated decision that a mother must make in the birthing process.  Hopefully this sheds a bit more light on it.  Have questions or comments?  Don’t be shy–dive right in!

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