Episiotomy is once again at the forefront of a study. For years the debate has raged about whether or not routine episiotomy presented any benefits for the laboring woman and her baby. Theories of smarter babies and less trauma were bandied about as well as better outcomes for the mother and her future sexual partners.
Recently a calm has come over the obstetrics and midwifery communities as it was gradually accepted that routine episiotomy had no place in modern birth.
According the the American College of Obstetricians and Gynecologist (ACOG), over one-third of all births included episiotomy in 1996. They say that this number is still too high and once again refute the touted benefits of routine episiotomy.
So this brings to mind the questions of when should episiotomies be done and on whom. A study released in the September 2000 issue of the Southern Medical Journal suggests that rather than using the old ways of "knowing" an episiotomy was necessary, one should look to the pregnant belly.
A small study was done in Louisiana on a group of women who were either given a routine episiotomy or not and "graded" on their stretch marks. The study was trying to see if there was any evidence suggesting that women who had more stretch marks had more perineal trauma.
In the study they concluded that practitioner attitude and practice did have something to do with the condition of your perineum following birth, with some interesting results. In this study of 168 women:
- Residents cut fewer episiotomies
- Attending physicians had fewer spontaneous lacerations
These findings are actually very contrary to what is found in the current literature about the use of episiotomy and lacerations in addition to episiotomy. Generally, if a woman is given an episiotomy her risk of tearing additionally is much higher than in the non-episiotomy group. The authors infer that the attending physicians simply knew more about protecting the perineum than the training residents did at the point of delivery.
Another odd factor that was not discussed in much detail in the study was the way stretch marks were categorized. A very simple scale was used by the residents after the delivery to grade the severity of stretch marks in the women:
- None
- Few (1-3)
- Moderate (4-6)
- Many (more than 6)
In the end these authors conclude that episiotomy should be restricted in birth, but that women with moderate to many stretch marks should be seen as much greater candidates for episiotomy than their non-marked counter parts.
Currently, stretch marks cannot be prevented. Whether or not you will have stretch marks is mostly up to genetics. However, adequate hydration and nutrition has shown to provide healthy skin which is known for its elasticity.
The best way to avoid an unnecessary episiotomy or laceration is still, literally, in the hands of the care provider you choose.
