Avoiding an episiotomy

My friend just had a baby last week. It had been a long time coming given the trouble she had conceiving. Being single and childless, I was curious about the details of the birth. She gave birth at a hospital with both a midwife and a physician attending. She felt it the best combination for a birth; a midwife offering comfort and female lore, and the physican offering a safe environment in case anything happened. Despite her birth plan, she endured an epidural and an episiotomy at the urging of the midwife and physician respectively.

My college roommate in the late nineties was a nursing major and was the first to introduce me to the concept of an episiotomy. I can still remember the swift downward cutting motion she gestured as she made a slicing noise through her teeth. It's an incision made in the area of skin between the vaginal opening and the anus, the perineum, so that the space can be enlarged for the baby's head. Episiotomies in the United States, despite their risks, are more common than caesarean sections with reported numbers ranging from 39% to 80% depending on the area of the country. During the birth, episiotomies can cause tearing into the rectum as well as an increase in blood loss. Post-partum, episiotomies are painful, with sexual intercourse still painful after three months. Other risks include a reduction in sexual sensation, urinary stress, and fecal incontinence. In rare cases, it can lead to gangrenous infections that can kill the mother.

Doctors, researchers, and midwives against episiotomies make the following analogy. Take a piece of fabric and pull two corners. It's difficult to rip until an initial incision is made, at which point it rips easily. They argue further that women who do not receive episiotomies tear no greater than the incision made during an episiotomy. Doctors for episiotomies argue that a clean incision will heal easier than a jagged tear. For anyone who has sliced through her finger with, say, a pair of yard clippers, this argument is quickly thwarted. Moreover, research shows that episiotomies are a deep incision which can cause more destructive, deeper tearing that is even more difficult to heal.

The episiotomy was invented during the 1920's, a time when there was a general distrust of the female body to do what it was built to do. The medical field made women to believe that their natural bodily functions such as menstruation, pregnancy, and menopause, were illnesses that required treatment. Moreover, DeLee argued in 1920 that it prevented brain damage in the baby as it prevented the pounding of the skull against the perineum. This is a foolish argument as the perineum is a piece of elastic skin.

Episiotomies aside, the whole of the birthing ritual is diseased in the United States. A woman is lead into a cramped hospital room and laid down on a bed where she must fight gravity and labor for the next 16 hours, the limit given by most HMOs for the length of labor. She is denied food, despite the grueling amount of work it takes to labor. If after 16 hours, she happens to "seize" (that is, her cervix stops dialating), she is given an epidural and episiotomy to hurry the birth via forceps, or in other cases, a caesarean.

American women do not need this kind of medical intervention to do what they were built to do. The myths and rituals surrounding the American way of birth are based on economic incentives (a caesarean generally adds $1000 to a medical bill), and anti-female notions generated during the Victorian era. Until conditions in the U.S. improve, at 6 months pregnant, I'll be on a plane headed for France.