by Jessi Vining I was nineteen the first time I saw a woman cut without her consent. As a wide-eyed baby doula I watched, my mouth hanging open, while the doctor sliced into my client’s flesh without using any anesthesia. She cried out in pain and surprise, and looked up at me in shock. This wasn’t supposed to be happening anymore, I thought.  I had just finished reading Episiotomy and the Second Stage of Labor by Sheila Kitzinger and Penny Simkin – a small book summarizing the research and evidence showing routine episiotomy to be harmful, rather than beneficial for parent or infant. That book had been published in 1984, and so I had assumed that by 2011 most (if not all) doctors would have abandoned the surgical procedure altogether. Sadly, no.The last eight years of birth work have shown me that the practice of routine episiotomy still hasn’t been eradicated like I once assumed, or even truly restricted to the “emergency-only” status many care providers like to claim. The History of Episiotomy An episiotomy is a surgical cut to the perineum with scissors or scalpel to increase the size of the birth canal and hasten the birth of the baby. The procedure is done during the second stage of labor. Though first described by a Scottish midwife in the 1740’s, episiotomy didn’t become a routine procedure in the U.S. until the 1920s. It should be noted that this was long before it was considered necessary to have research or evidence that a procedure was beneficial before adopting its widespread use. Despite the lack of evidence, episiotomy would remain a routine practice in the United States for the remainder of the century and by 1979, the overall rate of episiotomy in birth was 60%. Finally, in the 1980s and 1990s the first research papers on the effects of a procedure that had been used for decades were published and made available to practicing physicians.  There have historically been two primary reasons used to justify episiotomy: 1. To prevent severe tearing and promote better healing by creating a clean, controlled cut and 2. To reduce trauma to the fetal head or reduce the length of time the head is in the birth canal (such as in cases of fetal distress). It was immediately clear from the research that routine episiotomy did not carry the benefits many physicians believed, and in fact resulted in MORE severe tearing, increased pain and serious complications with healing postpartum. There were no clear benefits of routine episiotomy for the…

by Jen Marlow LM, CPM With the increasing accessibility of electronic pressure cookers has also come an increase in questions about their viability for sterilization of instruments. In meeting with World Health Organization and United States Food and Drug Administration standards, sterilization in at autoclave at 121°C and 15 PSI for at least 30 minutes is generally recommended. Many out of hospital midwives already successfully use pressure cookers intended for canning, or oven sterilization techniques, so it does not seem like a huge leap to consider using an electronic pressure cooker that needs little more than a button push after being loaded with cleaned and packaged instruments. The simplicity of use is not the only appeal. Most autoclaves are at least 10 times more expensive than a typical electronic pressure cooker. There are several electronic pressure cookers currently available that reach the necessary pressure and temperature. It is entirely possible to see color change on sterilization package indicators that show these conditions have been achieved. The primary concern, however, is that indicators on packaging only show that those conditions were reached at some point during the sterilization process. To meet sterilization standards, that level of heat and pressure needs to be reached and maintained. Until recently, there hasn’t been any clear evidence as to if any of these pressure cookers are consistently maintaining the necessary pressure and heat for the entire time. A 2018 study conducted at Dakota State University suggests that, yes, it is possible to substitute an electronic pressure cooker for an autoclave. Their results came with one big caveat though. Only one of the pressure cookers they tested met the criteria they were looking for. A variety of fungal and bacterial cultures were packaged and run through Instant Pot, GoWISE, COSORI, and Gourmia pressure cookers then cultures were incubated for one week before being checked for growth. Most notably, they were tested with Geobacillus stearothermophilus spores, a culture known to be heat resistant and commonly used to test that sterilization devices are functioning as intended. An Instant Pot with a sterilization setting was the only electronic pressure cooker that was able to successfully pass the spore test. The Instant Pot required a sterilization time of 150 minutes or more before the spores were inactivated, but the other pressure cookers tested were unable to inactivate the spores even at 300 minutes of sterilization time. This longer sterilization time…