
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…
Read More