Relieve en pared retratando un parto

Relief on wall portraying a childbirth

Earlier this month the association El Parto es Nuestro denounced a sign hung in a Canary Islands hospital, whose messages contradicted guidelines of official protocols in childbirth care. Even more serious was the support of the government of the Canary Islands and the Canary Health Service, both institutions appearing on the cartel. I am especially striking the following pattern: “To promote the realization of central vs lateral episotomies. Encourage intradermal”; and more when the Ministry of Health’s Normal Delivery Care Strategy clearly specifies that the epistomy will be medio-lateral, and its suture of resorbable material’.

It runs around a certain myth ensuring that episiotomy (for being a perfect and clean cut) is better than a tear, but is that true? Well, you should know that such surgical practice is not without risks, such as infections, or excessive blood loss. In addition, the risk of severe perineal trauma, or better perineal recovery using this technique is not shown to be reduced. It would also not be useful in reducing urinary incontinence.

Misconceptions about episiotomy.

Gráfico episiotomia

Episiotomy is a cut of the perineum (area between the anus and vagina) that is practiced during the expulsive, with the conviction that the baby’s exit is facilitated, preventing tears. But let’s think well: not only the perineal skin is cut, but also the tissues and muscles that connect them. Evidence discourages this surgical procedure on a regular basis, in fact, WHO itself clearly indicates that (if episiotomies are performed in a hospital) these will not be routine.

It is a surgical intervention, so it is associated with infections, poor scarring, abundant bleeding, pain in intercourse…; it is not at all harmless, and should not be used as often as it is done. There are certain beliefs that maintain the lack of confidence in the woman’s body, and physiological processes without intervention. On one occasion I heard an idea of the strangest thing in relation to episiotomy that justified it to prevent brain damage to the baby, who during childbirth is’ hit ‘against the perineum.

But you can give birth without interventionism, without tears, and without risks to the baby.

If you don’t want your perineum cut…

Find out about childbirth care practices where you want to give birth, see if they follow the strategies for normal birth care, talk tothe obstetrics service coordinator, submit a Delivery Plan, look for alternatives if you think necessary. Here we talked about the perineal massage to relax and strengthen the area; and you should know that giving birth freely, in the posture that the body asks you, and moving if necessary, facilitates the expulsive and without tears!

It is necessary to make it visible that synthetic oxytocin, monitoring, maneuvers like Kristeller,… put you at a disadvantage making labor difficult.

Have you had an episiotomy and you don’t know how to care for the cut?

Remember to wash the area with soap and water, also gently drying (better shower than bath), and if you can relax also after going to the water. Control pain with local ice or water and salt, taking painkillers (both ibuprofen and paracetamol are compatible with lactation). To get your perineum into shape after the intervention, consult your midwife, or a good physiotherapy professional, and be advised. If you have symptoms of infection (swelling, fever, redness…) go to a doctor.

Image — Wellcome Images