EPISIOTOMY – To cut or not to cut
I was hosing my horse at the horse wash the other day and I was privileged to chat with another adult rider who is also a general nurse (not a midwife). During our conversation she stated “There is a big division between Doctors and Midwives isn’t there!” She went on to say “I listened to the doctors discussing the view of midwives; that it is better to tear than to have an episiotomy in child birth, but doctors were saying that if women don’t have episiotomy, they can end up – in surgery repairing a 3rd or 4th degree tear and that episiotomy can prevent this”.
I decided not to attack my new adult riding buddy with my views, and instead said to myself “I need to write a blog about episiotomy” a topic that I am very passionate about, and a topic that seems to come up more and more these days as in my opinion, doctors and many midwives seem so keen to cut episiotomies compared to the doctors and midwives I worked with 10 and 15 years ago. They don’t seem to question it’s necessity, it seems to be one of the first things some doctors and midwives think about when it comes to ‘getting the baby out’.
Also, episiotomy appears to be readily performed for situations such as ‘slow progress in labour’ and ‘fetal distress’ or any heart rate variation in the second stage of labour (which may not be fetal distress – just decelerations of the fetal heart rate with head compression).
Episiotomy http://en.wikipedia.org/wiki/Episiotomy is a bad word!
In my opinion, there needs to be a very good reason to cut an opening in a woman’s perineum with a pair of scissors. In my 20 years of experience since being a midwife, I have cut 4 episiotomies (I’m not very experienced am I), and two of these were when I was a student, both of which I now believe were unnecessary. The other two were in sitautions where we had a fetal bradycardia, in sitautions where I was truly concerned about the wellbeing of the babies (both babies were fine).
Getting back to my new friends comments relayed from the conversation she had overheard in the workplace, women who receive episiotomy for spontaneous vaginal birth are more likely to end up having anal sphincter injuries, or 3rd and 4th degree tears. So episiotomy in spontaneous vaginal birth is not preventing severe tears, episiotomy causes more severe tears in these women
Also, it is my experience that women who receive an episiotomy are much more likely to experience pain, and have a higher chance of wound breakdown. http://www.ncbi.nlm.nih.gov/pubmed/23901667; http://www.ncbi.nlm.nih.gov/pubmed/15870418
There has also been research performed on assessing whether episiotomy reduces the incidence of babies dying during normal spontaneous vaginal birth and the research is suggesting that performing episiotomy is not associated with higher incidences of neonatal morbidity http://www.ncbi.nlm.nih.gov/pubmed/24786985
So for all women wanting not to have an episiotomy, you must discuss with your caregiver your wishes around not having an episiotomy. If you say ‘no episiotomy’ then an episiotomy can’t be performed, and your caregiver will have to discuss with you the reasons why they think an episiotomy is necessary before ‘assuming’ that you consent to having one performed.