Life is not tender with the female species. In many ways pregnancy is no blessing. The gift is to have a baby, of course, but your body endures a lot of hardship before the miracle of child-rearing. In addition to the many concerns that fill your nights and days during pregnancy, episiotomy should be one of them, we have decided to tell you about it so that you know everything about it.

What is an episiotomy?

Do You know when you push to get your baby’s head out? Well, if it doesn’t pass, the episiotomy will facilitate this passage with a small clear incision of a few centimeters in the perineal muscles. It may give you a small twinge, but you won’t feel any pain when the doctor makes the incision because you will be under local anesthesia, and if so, it is always done during a severe contraction. This incision is beneficial because it can prevent you from having deformed tears that would be hard to sew up and leave time for your body to heal. After your baby is born, the doctor stitches the incision back together so that it heals properly.

Before episiotomy was systematic, especially if you were expecting your first child, it was a kind of cultural practice. The practice is now controversial and its usefulness is seen as minimal.

the controversy around the woman’s body and intimacy

A few years ago, an episiotomy scandal occurred: some doctors used the episiotomy to sew up the vulva hole more than necessary to make it narrower and thus accentuate male pleasure during all sexual intercourse… And yes, it wasn’t that long ago, this repugnant act was denounced by many feminist collectives, placing episiotomy at the “persona non grata” stage because of sexist and misogynistic practices of which some women were not even aware that they had undergone an episiotomy during childbirth.

There were therefore, abuses of this practice, especially since today we know that episiotomy is not a 100% effective solution! And yes, it does not prevent all tears in the perineum, it does not necessarily reduce the risk of incontinence or organ descent. Episiotomy practices are therefore clearly decreasing, about 1 woman in 5 would need it, the main reasons being if the baby’s head is too big, or if the baby is suffering and it is necessary to accelerate the expulsion, if the perineum is too short or if forceps are necessary.

can you refuse an episiotomy?

More than a false and abusive practice, episiotomy is above all an attack, even a violation, on the woman’s body and intimacy. It is completely natural to be worried about such a practice. But rest assured that the law requires your doctor to obtain your authorization before any medical practice. No authorization = no practice! You can also make this mention in your personalized birth plan, which you will have given to the medical staff. However, you must discuss your fears with the staff following you so that they understand the situation and are not caught off guard on the day of the birth. After that depends on the case of each one, but sometimes it is better to take the risk of a small incision than to end up with tears that lead to side effects. So talk about it as soon as you have your prenatal visits and make your decision with all the relevant information!

be better informed about the practices of the location of delivery to make a decision

You can learn about the ethics and practices of the facility in which you plan to give birth before making your decision. Normally, they can give you the rate of episiotomy practice before you even choose them as the place of delivery. You too should be aware of the freedom you may have during childbirth, as the position of childbirth would influence the use of episiotomy. Dutch midwives have made this observation in more than 1190 births. The question: is there a position that better preserves the perineum and avoids an episiotomy? Note that for 12% of women, sitting has considerably reduced the use of this practice. However, and unfortunately, fewer episiotomies do not mean fewer tears in the second degree, since other factors are taken into account, such as the duration of delivery, the weight of the baby, the age of the future mother.

how to recover after an episiotomy?

After the delivery, the doctor will sew up the incision made for the expulsion of your baby. If you have had an epidural he will do it directly after, if you did not have it or its effects have passed he will give you local anesthesia to avoid pain. You may experience pain over about ten days, depending on the importance of the episiotomy and your sensitivity. In terms of care to enhance healing, they are not necessarily complicated, but you must follow them to avoid any infection.

Hygiene will be an essential element for healing! After the operation, the area can be swollen and you may feel tingling. Allow about two to three weeks for healing, during this period care should be taken to keep the wound dry and clean, this can be complicated because of lochia, but your hygiene must remain impeccable. In any case, your doctor will prescribe everything you need to clean the wound. If you want to regain some intimacy with your partner, you will have to wait and observe the healing, because each case is particular. If you develop an infection or an abscess, it will take you several months to recover.

​What do you think of the act of episiotomy? Would you categorically refuse it?

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