An episiotomy in labor, i.e. an episiotomy, constantly arouses a lot of emotions. Modern obstetrics is moving away from the routine incision of the perineum in childbirth because many studies show that it does more harm than good. Therefore, they should be carried out only in justified cases. And in Poland, the perineal incision is still a routine procedure that is difficult to avoid. Why shouldn't you have an incision to the perineum?

Routineepisiotomy in childbirthis barbaric. We are one of the few countries in Europe where little has changed in this respect over the last 20-30 years. In Polish hospitals, an episiotomy (episiotomy) during childbirth is performed in approx. 60 percent. women giving birth, and among those who give birth for the first time, the rate is almost 80%!In the 1970s and 1980s, the statistics were similar almost all over the world. And today? In Great Britain and Denmark, the incision rate is 12%, in Sweden 10%, in New Zealand - 11%. This is because the effectiveness of this treatment has never been proven.

Why shouldn't you make an incision of the perineum?

  • The incision not only does not protect against more serious injuries, but can contribute to them . During normal, normal labor (no incision), the perineum may rupture, but the most common injuries are 1st degree injuries (ruptures of the vagina and skin of the perineum without affecting the pelvic floor muscles). The incision, on the other hand, corresponds to a second-degree fracture, as it also involves cutting the muscles of the perineum, vagina and pelvic floor. Moreover, incised tissues are more easily torn further. Just as a piece of fabric is easier to tear when its edge is cut, so is skin and muscles - after cutting them, third and fourth degree fractures, i.e. extensive anus injuries, are more frequent. Research conducted by the American obstetrician John M. Thorp on a group of 378 women shows that all third and fourth degree fractures (there were 13.2% of them) were preceded by an episiotomy! In Poland, this percentage is much lower and amounts to approx. 2%, but it is exactly the same as ruptures in women who give birth without an incision. So the procedure does not reduce the risk of extensive trauma - it is the same.
  • Incision of the perineum takes longer to heal , it is more painful and prone toinfections. A first degree fracture heals well and quickly, while the incision is deeper, it requires suturing, which is not always done neatly. Badly adapted tissues cause long-lasting pain, formation of adhesions, lumps, etc. It can be said that such cases are not the fault of the fact that the procedure was performed, but that it was carried out badly. But what is this excuse for a crippled woman? Meanwhile, in a professionally conducted childbirth with perineal protection, in most cases no injuries occur.
  • It is not true that the incision prevents injury to the baby's head . In hospitals where the percentage of perineal incisions decreased by several dozen percent, no increase in cases of hypoxia or brain damage in newborns was found. The perineum is made of soft tissues, so the pressure on the baby's head does not injure it.
  • The perineal incision does not prevent the relaxation of the vagina after childbirthand the deterioration of the quality of intercourse, because it is performed when the perineal tissues are stretched to the maximum by the head. To reduce their stretching, the procedure would have to be performed much earlier, with the head higher in the birth canal. An incision, on the other hand, weakens the vaginal muscles and makes it difficult for them to return to the state before birth.
  • This treatmentdoes not prevent the reduction of the pelvic floor muscle tension , and thus - prolapse of the reproductive organs and stress urinary incontinence. According to a study in Sweden where the strength of the perineal muscles was measured (by holding globules of different weights in the vagina), women had the most weakened muscles after the incision. Also, the muscles of women without perineal injuries and after a physiological rupture were weaker (because they were stretched), but to a lesser extent.
  • Performing an epiziotomymay reduce the woman's quality of life after childbirth . For several weeks, the perineum is painful, the woman cannot sit or move, it is difficult for her to function normally and look after the baby. Complications after an episiotomy, such as further ruptures, infections, painful sutures, adhesions, may make intercourse difficult or discourage it altogether. There are cases when even 2-3 years after giving birth, women experience pain and pulling during intercourse. Some of them, after a poorly performed surgery, feel as if they had been raped - because the interference in their body was carried out completely without taking into account their opinion: without information as to why it is done, and even less without their consent.
Important

Why are there fewer cuts in the vertical position?

  • Childbirth then proceeds more smoothly, the cervix opens upfaster, oxygenation of the child is better, so less often it is necessary to finish it faster.
  • The pressure of the head on the perineal tissue is evenly distributed on each side.
  • The coccyx bends up to 30 percent. in relation to its position in the supine position, enlarging the lower opening of the pelvis.

If perineal delivery is performed professionally, no injuries will occur in most cases. An episiotomy is sometimes necessary but should not be assumed. Such a decision should be made in the delivery room.

When is an episiotomy necessary?

Of course, there are occasions when an incision is advisable or even necessary. The indications for its conduct are similar to those in the case of surgical deliveries, so first of all the risk of hypoxia of the child (asphyxia). The incision is also justified when the child is very large (over 4 kg), the giving birth has the so-called high perineum or there are adhesions (scars) from previous birth. Women who practice sports such as horse riding are also not very flexible. The World He alth Organization estimates that an episode should be performed in 5-20 percent. births.

Polish standard

Why is it still a routine procedure in Poland? Often times, an episiotomy is simply done to shorten the time spent in labor. Especially recently, it is important when there are more births, because women are born from the baby boom of the 1980s. But it seems that the main reason is habit and reluctance to change. Many obstetricians and midwives have fallen into the routine - they do not want to change anything, because they have been doing this for years, are reluctant to learn new ways of delivering labor, they hardly accept other than traditional delivery positions, etc. Many also consider the problem to be trivial. Parts of the environment are hard to understand that a woman may be anxious to avoid the incision. And it is obvious, because it is a surgical procedure that can result in long-term painful complications. Anyway, even when there are no complications, the perineum heals for a few weeks, which is not pleasant at all.

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