Earlier this month the association Delivery is Ours denounced a poster hanging in a Canarian hospital, whose messages contradicted guidelines of official protocols in childbirth care. Even more serious was the support from the government of the Canary Islands and the Canary Islands Health Service, both institutions appearing on the poster. I am particularly struck by the following guideline: “Favor the performance of central vs. lateral episotomies. Favor intradermal "; and even more so when the Strategy for normal delivery of the Ministry of Health clearly specifies that '"when necessary" the episotomy will be mediolateral, and its suture will be made of resorbable material.
There is a certain myth around that assuring that the episiotomy (for being a perfect and clean cut) is better than a tear, but is that true? Well, you should know that such surgical practice is not without risks, such as infections, or excessive blood loss.. Furthermore, it has not been proven that the risk of severe perineal trauma or better perineal recovery is reduced using this technique. It would also not be helpful in reducing urinary incontinence.
Misconceptions about episiotomy.
The episiotomy is a cut of the perineum (area between the anus and the vagina) that is performed during the delivery, with the conviction that the baby's exit is facilitated, preventing tears. But let's think about it: not only is the perineal skin cut, but also the tissues and muscles that connect them. The evidence advises against this procedure In fact, the WHO itself clearly indicates that (if episiotomies are performed in a hospital center) these will not be routine.
It is a surgical intervention, so it is associated with infections, poor healing, heavy bleeding, pain during intercourse ...; it is not at all safe, and should not be used as often as it is. There are certain beliefs that maintain the lack of confidence in the female body, and physiological processes without intervention. On one occasion I heard a strange idea in relation to episiotomy that justified it to prevent brain damage to the baby, who during labor 'hits' against the perineum.
But it can give birth without intervention, without tears, and without risks for the baby.
If you don't want your perineum cut ...
Find out about childbirth care practices in the place where you want to give birth, ask if they follow the strategies for the care of normal delivery, talks to the coordinator of the obstetric service, presents a Birth Plan, look for alternatives if you think it is necessary. Here we talked about perineal massage to relax and strengthen the area; and you should know that to give birth freely, in the position that the body asks of you, and moving if necessary, facilitates the expulsion and without tears!
It is necessary to make visible that synthetic oxytocin, monitoring, maneuvers such as Kristeller,… They put you at a disadvantage, making labor difficult.
Have you had an episiotomy and you don't know how to take care of the cut?
Remember to wash the area with soap and water, drying gently too (better shower than bath), and if you can also clean yourself after going to the toilet. Control pain with local ice or water and salt, taking painkillers (both ibuprofen and paracetamol are compatible with breastfeeding). For your perineum to get in shape after the intervention, consult with the midwife, or a good physiotherapy professional, and they will advise you. If you have symptoms of infection (swelling, fever, redness ...) go to a doctor.
Picture - Wellcome Images