Avoiding an Episiotomy
Get Through Childbirth In One Piece!
By Elizabeth Bruce
Part 2 – Avoiding an Episiotomy
The good news is that there are many things you can do to get through childbirth intact. Here are my suggestions, based on experience and careful research
- Choose Your Attendants Carefully – Episiotomy is almost never a voluntary event for the mother. I won’t say it has never happened, but it’s the rare woman who jumps off the table in the throes of labor, grabs the scissors, and gives herself a snip. The clinician is the one who makes the final decision to cut, usually when you are not in a position to argue. A recent study of 1576 first-time mothers shows that the number-one risk factor for episiotomy is who your care provider is. In one hospital study, midwives performed episiotomies on the fewest percentage of their patients (21.4%); faculty the next lowest (33.3%); while private providers did the most episiotomies (55.6%). The researchers’ concluded, “The strongest factor associated with episiotomy at delivery was the category of obstetric provider.” For midwives who deliver out of the hospital, their rates are often even lower. Birth center rates average about 7%. Some lay midwives have rates as low as 1%.
- Try a Waterbirth – Giving birth in the water significantly reduces your chances of receiving an episiotomy. In one British study, not only did water lower analgesia use and speed up labour, but the episiotomy rate was five times lower in the water birth group when compared to the control group. Michel Odent confirms these results: “On the occasion of his 100th water delivery, [he] reported that in 100 waterbirths he had attended, there were no episiotomies performed and only 29 cases of tearing, all of which were minor surface tears. One reason for the reduced rates of perineal damage in the water may be that women find it easier to relax in a tub of water. For many women, immersion in warm water during labour is a dream come true. The water pool gives a sense of privacy. It also lowers the woman’s blood pressure and reduces pain. As a result of these factors, labour is often quicker in the water.
- Hire A Doula – Hiring a doula is a great asset for keeping your perineum intact. A doula is a woman who stays with you during labour and helps both you and your partner to feel comfortable. She provides emotional, physical, and informational support during labour. Historically, women in labour have had other women (their mothers, sisters, or aunts) with them. It is possible that just having another women with you during labour helps reduce blood pressure, stress, etc. Whatever the reason, doulas work. In one study, the presence of a doula resulted in a 60 percent reduction in epidural requests, and a 40 percent reduction in forceps deliveries. Both procedures are major contributors to high episiotomy rates. As a bonus, labours are shortened an average of 25% and cesarean reduced by 50% with a doula.
Why a Tear is Preferable – In general, a tear is smaller than an episiotomy, often occurring only in the skin, instead of the skin and muscle like an episiotomy does. If the laceration is stitched, a tear is easier to “line up” than an episiotomy, which may be stitched incorrectly and require more painful and lengthy healing time.
One study involving thousands of women found that the number-one risk-factor for perineal tearing was episiotomy. It really should not be surprising that cut perineal tissue tears easier than intact tissue (try it with a piece of cloth – you’ll get the picture). First-time mums delivering in the hospital are more likely to tear deeply (82% vs. 38% of later babies).
Women who have a scar from a previous episiotomy or tear often worry that they will tear again along the same line. While tears sometimes do occur along the old episiotomy line, in general, scar tissue is stronger than regular skin. Because scar tissue is also less pliable, some midwives recommend rubbing hypericum ointment into the area prenatally to prevent re-tearing. Susun Weed, author of Herbal for the Childbearing Year, recommends hot compresses of herbs like Plantain or Comfrey leaves during labour.
Certainly, you will want to be extra careful to avoid tearing, but many women with previous episiotomies have gone on to give birth intact, often to bigger babies!