There is one specific event that was the impetus for writing this article. Recently, friends of ours were expecting their first child. When she went into labor, the couple drove to the hospital where she was “drugged, cut and, after a while, out popped the baby.” Disturbed by their story, my husband asked them, “did she consent to the episiotomy or pain medication?” A little confused by the question our friend matter-of-factly replied, “well, no. we didn’t know it was an option.” Later that night, my husband warmly confided that he was so glad that I chose to have a midwife. He couldn’t imagine the alternative of having what the majority of women have: a doctor-controlled birth. It is this all too common scenario that has inspired me to present the following information for anyone who is or knows someone who is pregnant.

Did you know that episiotomies are the most common surgical procedure that obstetricians will perform in their lifetime? Theoretically, it’s intended to facilitate birth in an emergency during labor. But recently, especially in the United States, it has become the subject of much debate due to increased routine use. Resources show that the rates of episiotomy in the U.S. rank among the highest when compared to other industrialized nations. Statistics vary stating that it’s performed during at least 50% (in many cases as much as 75%) of all doctor-attended U.S. births. In contrast, midwife-attended births demonstrate rates of episiotomy that are radically lower, if at all.

I sought to uncover the real story behind episiotomy use, how it is performed and the differences in recovery experiences of those who’ve had it versus those who haven’t. What I discovered is that the current practices are in dire need of change. I learned the shocking reality of the permanent damage inflicted by episiotomies and the alarming lack of concern in the Obstetric community.

An episiotomy is a surgical incision made to widen the vaginal opening. The incision is made through the perineal muscle (perineum) between the vagina and the rectum. In general, there are two approaches. The midline incision cuts straight toward the rectum. The sideline or mediolateral cuts at a 45 degree angle. The more commonly used midline can likely tear straight to the rectum (called a third or forth degree tear) causing severe damage. In contrast, the sideline doesn’t usually tear further, but it causes greater blood loss, does not heal well and can be much more uncomfortable in the long-run. Both types of incision must be sutured directly following birth and are highly susceptible to infection before the mother is even discharged from the hospital postpartum.

The recovery period after having an episiotomy is approximately three to four weeks (in some cases months.) Until fully healed, the repair remains susceptible to infection. Recovery is described by many as being very painful wherein most mothers find it difficult to even walk.

In the recent past, episiotomy allegedly prevented postpartum incontinence or pelvic floor relaxation — a condition which hinders sexual pleasure and perineal muscle control. Research now suggests episiotomy does not prevent but rather causes these afflictions when the muscle is severed. Some women report that their experience of incontinence is far worse than they would’ve imagined. Some young women report having to wear adult diapers or pads because they experience so many “accidents.”

Women who underwent episiotomy were also more likely to report that they were still experiencing pain more than six months postpartum, especially during sexual activity. One of the most explicit long-term effects from the incision is permanent deformity of the vaginal area—a consequence some outspoken activists have compared to female mutilation.

When episiotomy is not performed, women either don’t tear at all or if a tear does occur it can be repaired much easier than a surgical incision. Research proves natural tears heal quicker with much less pain and discomfort initially and long-term. Repaired tears usually heal within a week or so. Likewise, when allowed to proceed without incisions, women were able to quickly resume daily activity (ie: walking) immediately postpartum. Normal functions of continence, physical activity and sexual intercourse resume within three to six weeks postpartum.

Curiously, there is no set criteria for making an episiotomy. Ideally, the procedure is intended to intervene in complications of labor when mother or baby is in immediate danger. However, emergency is rarely a factor in real life hospital delivery rooms. Many resources point to the reality that most doctors simply don’t want to wait for nature to take it’s course. Below are events that most frequently prompt use—the majority of which are doctor-inflicted circumstance rather than naturally occurring emergencies.

• the mother or baby’s heart rate becomes extremely high or low
• rapid progression of labor most often caused by over-medication of the mother; the baby enters the vaginal opening too quickly for the area to adjust and stretch causing potential for an extreme tear.
• though uncommon, sometimes a baby turns into a breech position (laying sideways or “shoulder first”) during labor.
• the doctor decides that baby is too big to fit through the mother’s pelvic canal and cuts a wider opening. *Statistics show a baby is almost never too big to fit through a mother’s pelvis.
• the laboring woman has been over-medicated, barely conscious and can not push; the Ob chooses to use forceps or vacuum to pull the baby out; an incision is made to widen the area.

*Forceps and vacuum are dangerous instruments that have been extensively reported to cause serious damage to both infant and mother.

See Part Two: A Call for Awareness and Change

See Five things you can do to prevent an episiotomy

Resources:
americanpregnancy.org
acog.org
childbirthconnection.org
bmj.com
jwatch.org
midwiferytoday.com
A Wise Birth: Bringing Together the Best of Natural Birth with Modern Medicine by Penny Armstrong and Sheryl Feldman
Ina May’s Guide to Childbirth by Ina May Gaskin

An introduction to the Natural Childbirth Series

For a pregnant woman, it can be overwhelming to sift through the vast amount of often contradictory information and advice from prenatal to postpartum. And, for a first time mother, there are certainly many, many decisions to make. When selecting a physician or midwife to attend pregnancy and childbirth, we are met with so many points to consider.

* What are the procedures that our health care team will or won’t perform?
* What level of support and information will or won’t they provide?
* What quality of caring and compassion will or won’t they exhibit?
* What kind of encouragement and confidence will or won’t they inspire in us as we prepare for the greatest challenges of parenthood?

What kinds of answers do we really expect from asking these questions?

In our consumer-driven culture, women can be perceived as just another a demographic to which products and services are sold. And, I have to wonder, is our health care any different? Are our health care options just another service to be marketed? And, if so, I wonder how this influences the collective perception of what we women think we can do; what we think we are capable of. With so much rhetoric swarming about, do we ever really have the opportunity to decide for ourselves what we are capable of? Do women collectively feel strong and empowered? Do we feel comfortable in our own skin? Do the common avenues of media encourage women to embrace our womanliness? How much does shared opinion affect our choices, medical or otherwise?

I believe that the fundamental reason why women may choose not to have a natural childbirth lies in the way we have been taught to view our bodies; to view ourselves. I have always had the opinion that cultural norms run in a vicious circle powered by the betterment of the establishment rather than the greater good of the collective—what ever can make big business the most money is what is force-fed to our psyches.

While taking the stance of compassionate rebel, I’ve always tried to do my part in encouraging others to find their own truths. I’ve always believed that the widespread benefit of health and wholeness is possible. In relating this position to childbirth, my first pregnancy inspired many questions in me. I began to read as much as I could about my options for prenatal care and labor experiences. And, unfortunately, I was shocked and saddened by what I learned.

The part of the Hippocratic oath that states “keep the good of the patient as top priority” had been lost in the actual practice many physicians employ. I started to question— why in my own experience do physicians never seem to portray their role as an educator of health? Instead, of proactively educating patients about healthy life choices, they have taken to focusing on disease. And, in the case of labor and delivery, it seems to me that doctors treat the event as a disease to be medicalized rather than a natural event to guide and protect.

I found evidence of these attitudes in many sources. To cite just one example: The bestseller Your Pregnancy week by week—a book millions of women have come to trust as a reliable guide—addresses the subject of natural childbirth on less than one of its 380 pages of content. While I have nothing personal against the authors, I have to wonder why they choose language that doesn’t exactly inspire confidence in a woman’s natural ability to birth. The authors spend the small space convincing women not to feel guilty when they’ll inevitably need medical interventions. They offer exactly zero space presenting even a short list of the benefits of natural childbirth. Nowhere can be found a positive statement such as, “natural childbirth is worth considering.” I know I am not the only woman who thinks there is something missing here.

In many cases, I found the relentless promotion of the perception that birth is a horrible, painful experience to be feared. Thus, mothers hear: Dull the pain. Anesthetize your feelings. Get it over with. Ad infinitum.

And so, it is my intention to do what so few others are willing to do: inspire confidence in women.

In my search for a positive authority on the subject, I did find several sources who encourage women to embrace what can be a beautiful, fulfilling event. I want to do my part in making these resources more widely known. Why not open discussion about the natural capabilities of a woman? Why not discuss the true facts about the adverse effects medical interventions can have on healthy moms and babies? Why not ensure positive resources of information are more widely circulated among the masses? Why not invite women to embrace what society tries to stifle—that we are intelligent and hungry for knowledge; that we are beautiful in all proportions; that we are proactive about our health and wellness; that we are built to conceive, nurture, and birth our children.

And, when we consider the facts, we are willing and able to make choices for ourselves.

Next Up in the Natural Childbirth Series:

Medical Interventions: Developed for crisis and emergency

So often, experienced mothers and health care professionals have compared childbirth to running a marathon—acknowledging that it is a very strenuous event that is best served by mental, emotional and physical preparation. In the coming weeks, earthmother.org will be addressing some of the many considerations women face and decisions to be made during pregnancy and childbirth. With growing resources of information available, we’ll focus on the more natural approaches and, hopefully, touch on options you may have wondered about or perhaps never even heard of—even from your medical team. We begin our foray into natural childbirth techniques with a list of five activities that have been proven to not only improve the quality of your experience of pregnancy and childbirth but will decrease your chances of complications.

Always consult your physician or medical team before beginning any new exercise or activity, especially if you have a high risk pregnancy. Information provided by earthmother.org is never intended to replace the advice or orders of your doctor/midwife.

1. Kegel exercises-
The easiest way to physically prepare for the actual “birth” part of childbirth. Kegel (or pelvic floor) exercises are simple muscle contractions that will strengthen and prepare for the stretching of birth and the “getting back to normal” afterward. Proven to increase your ability to control your pushing during birth while lessening the possibility of such unpleasantries as tearing and need for an episiotomy, hemorrhoids, and postpartum incontinence. Speaking of postpartum, doing your kegels will get you back in the sexual saddle much quicker and will likely improve your potential for pleasure much sooner than you thought possible.
To do Kegels:
Remember to breathe normally
*To find the correct muscles, practice stopping the flow of urine when urinating. This is called contracting the pelvic floor muscles.
*Hold for 10 seconds, then relax. Try not to contract legs, buttocks, or abdominal muscles.
You can do a series of “short holds” (5-10 seconds) then a series of “long holds” (10-20 seconds)
repeating 10-20 times for a full session of Kegels.
*It’s recommended to do a session two-to-three times a day.

2. Perineal Massage- An invaluable technique that prepares you for what the crowning will feel like and how to breathe through the discomfort of stretching. Yes, this will literally be a preview of what the birth will feel like (without the distraction and pain of contractions.) And, who knows?! You might become so prepared that when you do birth your little one, it may feel (dare I say) effortless. Should be done with a gentle touch and lots of love (and K-Y!) And, let’s not forget, that it gives you and your partner added intimacy and closeness during the last trimester of pregnancy. For instructions on proper method: Childbirth.org’s perineal massage reference

3. Find a Chiropractor you trust and have regular spinal adjustments-
As most Chiropractors are trained to treat pregnant women, the biggest concern is probably to find one with whom you are comfortable. Many DC’s carry advanced certifications in a variety of pregnancy related treatments from infertility to turning breech babies (the Webster technique.) Spinal adjustments will greatly reduce and relieve aches and pains of the changing pregnant body as it experiences shifts in weight distribution and added pressure placed on vertebrae, muscles and joints. More importantly, chiropractic has been proven to shorten the length of labor and delivery, ensure the baby will descend into the proper head-down position, and prevent complications that lead to unnecessary cesarean sections. Go to icpa4kids.org to find a Chiropractor or to read pregnancy, birth and childhood articles that focus on natural lifestyle choices. For a personal story of how the Webster technique painlessly helped turn one mother’s baby, see our chiropractic adjustments ease pregnancy article in the natural childbirth section.

4. Walk, not necessarily run-
Walking has countless health benefits and this form of exercise can begin as soon as you get your doctor’s OK (as opposed to jogging or running which is generally approved during pregnancy only for those who have a history of these activities.) All you need is to acquire a comfortable pair of walking shoes and you’re ready to go. If you’re not used to walking for exercise, do ease into it. Once you’ve established a routine, you may feel you have more energy accompanied by a general feeling of wellness as the pregnancy progresses. Walking will prepare you for that marathon of birth by increasing endurance, building muscle tone, deepening breathing capacity, releasing tension —all priceless skills to have when your in the thick of hard contractions, bearing down and pushing.

5. Drink plenty of water. Lose the plastic bottle-
Being well hydrated during pregnancy has so many important benefits. Drinking enough water will make for healthy skin that will stretch easier (with a growing belly as well as the crowning of the head during birth) and return to it’s normal shape quicker. Adequate hydration will also prevent common pregnancy ailments such as bladder (urinary) infections, headaches, muscle cramping, constipation and hemorrhoids. Last, but certainly not least, it will ensure that your baby is getting all the necessary fluids, oxygen and nutrition needed to develop and thrive. While the jury is still out on how much of the plastic chemicals from water bottles leaches out into the liquid, be aware of your water sources. Many reports are now revealing that bottled water is nothing but tap water that’s occasionally fortified with added minerals. So, drink filtered tap water when you can. You’ll be erring on the side of caution not to mention saving money. And, you’ll be helping out the environment by reducing waste. A report recently published in Parents magazine cites research suggesting that up to 86% of plastic water bottles do not actually get recycled and end up in landfills.

Useful resources:

http://americanpregnancy.org

http://www.birthingnaturally.net