Thirty one percent of women having their first babies and 36 percent of those having their second or subsequent baby had no tears or episiotomies. This increased rate of preservation of the perineum was probably due to the use of midwives and nurses to deliver most of the babies. Women in the restricted episiotomy group were more likely to resume sex within a month after delivery. There was a substantial saving in staff time and suture materials in the restricted group.
Alternatives To Episiotomies
In other developed countries, midwives, partially because they were not trained in surgery, became skilled at assisting women to birth their babies without either tears or episiotomies. During their training midwives are specifically instructed in the gentle art of easing the baby into the world without harm to mother or child.
In fact until 1930, similar instructions were also given to doctors on how best to protect the perineum and avoid tears.
On the other hand, the now "routine" episiotomy cuts through skin, vagina, mucosa and three layers of muscle in a sensitive erotic zone. Side effects of episiotomy include pain, bleeding, (especially when the episiotomy is done too soon) breakdown of stitches, and delayed healing. Pain following an episiotomy is often considerable, preventing women from sitting down comfortably for the first week after birth and sometimes for several weeks.
In a small minority of women, painful sex persists for several months after the birth or longer. One of the few studies that has been done on this topic showed an incidence of persistent painful sex after an episiotomy of six percent. Women with episiotomies are more likely to report painful sex than women who have had second degree tears that had to be stitched. A recent Australian study showed that 20 percent of women with episiotomies had painful intercourse for more than six months after the birth, and many in this group had prolonged discomfort even after that time.
The renowned childbirth educator and author Sheila Kitzinger points out that, although for some, episiotomy is a minor cut that heals quickly, for many women, it is a wound that leaves them feeling scarred. She believes that the episiotomy can also negatively affect the woman's body image and how she relates to her sexual partner.
Prevention During The Pushing Stage Of Labour
Dr. John Milligan, Obstetrical Director of the Regional Perinatal Unit at Women's College Hospital in Toronto says most women "do not need an episiotomy, even if it's their first pregnancy, as long as the delivery is controlled and the doctor has the mother's co-operation." He adds that possibly 20 to 25 percent of first time mothers may need an episiotomy or suffer a small tear, "depending on the size and position of the baby."
The prime goal of both mother and doctor is to have the baby's head emerge as slowly as possible, preferably between contractions. To prevent tears or the need of an episiotomy, the pushing stage of labour should be unhurried. And that requires the conscious co-operation of the mother and clear and effective communication between doctor and mother.
Sheila Kitzinger was the first person to describe a natural pause of one half to one hour or more, that occurs during some labours, between the time the cervix is fully opened up and time the urge to push begins. Her advice was to rest and be thankful.
Some research has indicated that prolonged breath holding and strenuous breathing during the pushing stage of labour can interfere with oxygen getting to the baby. It is far better to push for shorter periods of times, only when the urge is overwhelming, and to try to keep the mouth loose and relaxed while doing so.
One British obstetrician, Dr. C.L. Beynon, advocates that women not be given any instructions to push whatsoever. He notes that women do not naturally push until the baby's head is right down on the pelvic floor. This also gives more time for the perineum to stretch.
It is naturally much easier to push when you are squatting, semi-upright, lying on your left side or any other comfortable position. Pushing while lying flat on your back goes against the forces of gravity and is usually the most difficult position from which to push a baby out.
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