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Cascade Christian Childbirth Association
A small incision in the perineum to facilitate the birth of the baby ~ Midline (Straight down) ~ Mediolateral (Diagonal) ~ “Hockey Stick” (Down and over) THE BENEFITS Opens an unusually tight perineum Facilitates the birth when the baby is in distress Shortens second stage labor Easier for care provider to repair THE PROBLEMS Increased blood loss Increased risk of a more serious tear (Most third degree tears happen after episiotomy) 199 Poor healing after delivery o Natural tears zip back up and are less likely to break open Longer healing period than a tear More painful than a tear Discomfort during intercourse Pain at the site of the scar Am J Obstet Gynecol. 1997 Feb;176(2):411-4 Most doctors do not, and should not, routinely practice episiotomy anymore, because it can cause serious damage to the perineum. Renew your mind in thinking that you will tear greatly if you don’t get an episiotomy. Let’s talk about tears. First degree – When only skin is separated Second degree – When skin and muscle are torn Third degree – When the perineal muscle is torn into the sphincter muscle Fourth Degree – When the tear extends all the way through the rectum. The majority of all third and fourth degree tears happen after an episiotomy is performed. It is like trying to tear a bed sheet. If you pull on it with your bare hands, it can be difficult. If, however, you snip a small cut, it rips very easily. Much the same, your tissue will be more likely to remain intact if you do not snip it. The majority of serious tears that happen without an episiotomy are the result of poor management of the perineum. If a woman is lying on her back or semi-reclining, the baby’s head is being pushed up and out, away from gravity against the perineum. This extra pressure is generally what causes a tear, because this is an unnatural position to be in. It is most convenient, of course, for the attendant to see what is going on. It is not the safest, however, because it pushes the tailbone and sacrum in the way of the space for the baby to come through, puts undue pressure causing a tear, etc. If a woman is on her back while pushing, the attendant must be managing the perineum in order to prevent a tear. This takes skill, and physicians are now learning how to do that instead of cutting the tissue. It is much easier and safe, however, to be upright in a squat, or lying on one’s side, so that the pressure on the skin is more natural. |
| EPISIOTOMY |