Every year our family dyes eggs for Easter, and this year my three little girls couldn't wait to get started working on their creations. After we'd colored a few eggs, my oldest daughter pulled out some plastic shrink-wrap covers, a hairdryer to shrink the covers, and started to attempt to pull the design onto the egg. After a few seconds she said "Mom, it isn't fitting! The egg is too big!". I tried to help her pull the cover on, but again, within a few seconds she was expressing her frustration with the situation. I asked what she wanted to do and then came the response, "maybe we should cut it".
Seizing this opportunity to use as a teaching experience I explained how that might work, but that it might also end up tearing a lot farther than the original cut when we try to push the cover onto the egg. A little reluctantly she said she wanted to try it. I made a tiny 1/4" cut into the wrapper, then carefully tried to pull the cover onto the egg, and as I did she cried out because the once tiny cut was now stretched open almost to the other end of the wrapper.
What is an episiotomy, and why might it be performed during a birth?
An episiotomy is an incision made in the perineum(the area between the vaginal opening and the anus) to widen the vaginal opening to aid in the delivery of a baby. According to a statement made by ACOG in 2006, episiotomies were originally indicated for cases such as "abnormal labor progression, non-reassuring fetal heart rate pattern, vacuum- or forceps-assisted vaginal delivery, and shoulder dystocia." Unfortunately, the use of the episiotomy became more of a routine method for speeding up delivery, and the reasoning given was that it would "reduce the risk of spontaneous perineal tearing, subsequent pelvic floor dysfunction, urinary and fecal incontinence, and sexual dysfunction."
"A woman's body knows how much room it needs to birth a baby, and does a magnificent job of determining that amount if given the opportunity."
After reviewing the data, ACOG found that women who had an episiotomy did not have significantly better outcomes than women who did not have one performed and their position states that "[t]he use of episiotomy during labor should be restricted." What has also been discovered is that the very damage that we would want to avoid, is actually a common outcome of having an episiotomy. When an episiotomy is performed it is near impossible to make a cut only up to the exact amount needed to deliver a baby, and even then the tearing will often continue along the line of the incision as the baby is birthed. On the other hand, when a woman is supported in allowing her perineum to stretch during the pushing stage, if she does end up tearing it most often will only tear up to the amount needed to deliver her baby. A woman's body knows how much room it needs to birth a baby, and does a magnificent job of determining that amount if given the opportunity. When extensive tearing happens during a birth it is often a result of an environment that doesn't encourage the mother to listen to cues from her body as she pushes out her baby. Some common examples of an unfavorable environment include laying in an unnatural position (such as flat on her back which still remains a routine position in many hospitals) and/or from directed pushing such as "purple pushing" where a doctor or nurse tells the woman to hold her breath and push as hard as she can during a contraction(also common practice in many birth settings). Neither of these practices encourage the mother to listen to her body and follow cues for when to slow down, pause, or stop pushing all together so the baby can descend in a careful and controlled way.
When an episiotomy is necessary
As is the case in many procedures there are times when an episiotomy is necessary and has resulted in better outcomes for mom and baby. In those cases, it is vital to have a provider that you trust to know the difference between when an episiotomy needs to be performed, and when to allow time for your body to do what it was meant to do: slowly stretch and ease your baby out during the pushing stage.
To increase your chances of avoiding an unnecessary episiotomy you may want to hire a doula who can help you know the right questions to ask your provider, and what red flags to look out for that might indicate your provider isn't a good fit for the birth you are looking for. She can also help guide you through the process of labor and birth and support you so that you have the emotional and physical stamina to allow the pushing stage to unfold naturally and safely. Researching and signing up for a great childbirth class will also help prepare you for the many facets of labor and birth, and will aid you on your way to a safe, positive birth experience.
When my daughter and I continued with the rest of the eggs, she brought me another shrink-wrap cover and an egg and asked "will you help me put it on carefully?". We slowly eased the wrapper onto the egg, little by little, and after it was successfully applied we looked back at the two and as we did she glanced at the egg with the cut wrapper, then looked at the egg with a wrapper that was still intact and said "I think it's so much better when we just put it on carefully so we don't have to cut it". I couldn't agree more.
~Callie Corless - Birth Doula and Prenatal Dance Instructor in Dallas - Fort Worth, TX