7: How to avoid an unnecessary episiotomy

It's an uncomfortable conversation. You may be told that a cut is better than a tear but a tear sounds terrifying! A recent Cochrane systematic review examining the evidence on selective versus routine episiotomies for vaginal birth concluded: “Overall, the findings show that selective use of episiotomy in women (where a normal delivery without forceps is anticipated) means that fewer women have severe perineal trauma. Thus the rationale for conducting routine episiotomies to prevent severe perineal trauma is not justified by current evidence, and we could not identify any benefits of routine episiotomy for the baby or the mother.” Despite this recommendation, health workers sometimes encounter institutional barriers that pressure them to perform the procedure. Fear of a woman developing a third or fourth degree perineal tear and a lack of proper training can also contribute to high episiotomy rates.Evidence shows that episiotomies do not protect the perineum during birth and in fact increase the chance of a third or fourth degree tear. Once the cut is done the baby’s head emerging causes the cut to tear deeper into the muscle. Tears will heal much better than episiotomies as well. The scar tissue from an episiotomy can be weaker but will not restrict the perineum’s ability to stretch in future births. A previous episiotomy is not an automatic reason for an elective c-section.In this episode I talk about some of the things that you can do to prevent an unnecessary episiotomy. Please connect with me on my Facebook page  so that you can be kept up to date with the extensive resources that I am putting together for you about episiotomy.