I have been thinking about perineal support a lot lately, yes these are the things that run through my brain. I have a close connection with the varying levels of perineal pain that my clients experience in the postpartum. I see time and time again how much more pain women experience if they were given an episiotomy as apposed to natural tearing or an intact perineum. I am proud to say that in my 7 year career as a midwife I only performed 3 episiotomies, all of which were due to emergencies and every time with the consent of my client.
When interviewing new clients, I will ask them of their fears or concerns about birth. Many women voice being afraid of episiotomies. I validate these fears, no one wants to be cut on the perineum at birth. Perineal tissue for the most part is able to stretch and if it does need to tear it will take a gentle route, much more gentle then the scissors choose.
I write this blog with a slightly heavy heart, because I would like to say that Israel is forward thinking that there are not many episiotomies being done here and that a woman’s consent is always taken.
“Ensuring that women are involved in the decision-making process in the event that an episiotomy might be needed is also critical. Performing an episiotomy—or any other intervention—without a woman’s informed consent is a violation of her right to respectful maternity care. Addressing the non-evidence-based use of episiotomy is key to improving maternal health and women’s birthing experiences worldwide.” For further information please visit this link
Non-evidence based use of episiotomy is still very common unfortunately. I understand that episiotomies can be a life saving procedures at times, if used within an evidence based way. “Research has shown that natural tears typically are less severe (although this is perhaps not surprising since an episiotomy is designed for when natural tearing will cause significant risk or trauma). Slow delivery of the head in between contractions will result in the least perineal damage. “ For further information please visit this link
Of course when I am in an Israeli birth room with my client in the capacity of their Doula, I will never interfere with their doctor or midwife needing to do an episiotomy in a true emergency. What I will do is to try to prevent them in situations where there is not an emergency. I will advocate for my client to have a chance to birth her baby without being cut. I celebrate those moments for my clients when an episiotomy is prevented and their perineum stretches beautifully or if it did tear it only was minimal and healed easily. It brings me joy when the women I support are able to recover in the postpartum a little more easily with less perineal pain. Some may call me a anti-episiotomy vigilante, so be it, if I can help promote trust in women’s bodies to birth their babies then I will take that title for the cause of no more unnecessary episiotomies.
I wish for all women freedom of movement for their vaginal birth, that they can choose the position that is comfortable to them and not because it is convenient to their practitioner. That they are given warm compresses, and oil is used and that their perineum is supported in a way that promotes an intacted perineum. That there is a trust and communication between them and their care provider to slow down the birth of the head of the baby. That women feel safe to birth with dignity, power and that their voice is always heard through consent.