Episiotomy, Cut or Natural tear?

[Guest guest]

C-sections and their benifits/problems have been discussed in this

column in a large number of posts. After suffering through a vaginal

birth, serious tears and subsequent incontinence, anti-biotics

related problems etc., one of the patients had an elective C-section

and has recently delivered second daughter. Despite pursuation that

she can have a comfortable VBAC. So the temptation to undergo an

established relatively painless procedure is natural. Here the

acievement of modern science needs to be praised.

 

The objective of this post is, however, to bring out the fact that

the present research and opinions are now tilting towards allowing

the nature to take its own course. The theories of physics

(elastodynamics, fracture mechanics) also support some of the views

expressed in research summary presented below.

 

An episiotomy is a standard procedure that's performed on over a

third of all women having a natural birth. But as with so many

surgical procedures, it's not properly tested, and so it cannot be

proved to be the safest, or most beneficial, practice. The

term "tearing" conjures up images that most women would rather not

consider. Actually, tears often are small and do not extend into the

muscle. When an episiotomy is cut, several layers of tissue and

muscle are cut. Tears also tend to heal more comfortably than

episiotomies. This may be because the skin has separated down

anatomical lines and the tissue has not been crushed, as it is when

scissors are used.

 

New research suggests that the episiotomy should rarely, if ever, be

performed. A research team from North Carolina University concluded

that the procedure offers no benefit to the woman, and it leaves a

legacy that can include incontinence and painful intercourse.

Doctors who perform an episiotomy often cause more damage to the

woman than if she had had a natural birth without any intervention.

Many of these long-term injuries have been caused by doctors who

perform what is known as a 'midline episiotomy', compared with the

more familiar 'mediolateral' incision.

 

Sometimes an episiotomy is needed, but the rate could comfortably be

halved without affecting the birth process.

(Source: Journal of the American Medical Association, 2005; 293: 2141-

8).

 

To prevent lacerations, it is important to listen to the midwife or

doctor carefully and to give small controlled pushes. Occasionally,

the mother may be asked to push between contractions so the force of

the contraction does not cause her to push with such force.

If the baby shows signs of distress, or if the midwife or doctor

believes that a tear into the deep muscle or into the rectum is

inevitable, an episiotomy will generally be cut. But research has

demonstrated that the highest incidence of rectal sphincter and

rectal lacerations occurs when an episiotomy has been cut.

 

Many variables go into the decision whether or not to cut an

episiotomy and how to support the perineum at the time of birth. The

best advice is to choose a care provider or a type of care provider

who will work with you, listen to you, and minimize the use of

routine procedures in their practice.

 

http://articles.health.msn.com/id/100108714/site/100000000/

 

At least part of the problems brought in by episiotomy could be due

to scalpel probing an area where a complex network of nerves exists.

Unintentionally, some nerves receive the damage. Healing of tissues

and nerves is not equally rapid. There are many surgeries wherein

total loss of leg mobility has been experienced due to stiffening of

joint, while surgery aim was to reapir a displaced hip joint. Unlike

U.S., in India, patients blame such an outcome on their own fate. If

God did not want cure, what doctor can do?

 

Dr Bhate

 

[ Above views are the published ones and are included here with

original reference links. The objective is to show that the opinions

are changing world over]