How to Avoid Episiotomy
Angela Monti Fox, LCSW

The following is a brief summary of several studies showing how Episiotomy considered "routine" and practiced widely in the United States, has little scientific reason for it’s continued use. In fact research on the Kegal exercise and the Perineal Massage show a significant reduction in "Episiotomy and Perineal tearing" when these two approaches are practiced.

HypnoBirthing is as much a philosophy as it is a method of childbirth. As such, our childbirth education course in HypnoBirthing includes careful attention to alternative methods that can help prevent unnecessary medical intervention. Thus we not only teach women to practice perineal massage and the Kegal exercise in order to reduce and in most cases avoid unnecessary episiotomy and tearing, we also use post hypnotic suggestion to encourage, motivate and support the practice of Perineal massage and the Kegal exercise.

What is Episiotomy and is it really necessary? An episiotomy is a surgical incision in the perineum, the area of skin between the vagina and the anus. It use has been routinely defended by the medical profession as necessary to prevent tearing, protect against incontinence later on in life and aid pelvic floor relaxation during delivery. In addition, it is claimed to speed up birth, prevent damage to the baby, and heal easier than spontaneous tears that may occur during delivery. In spite of the prolonged insistence of the medical profession as to these outcomes medical research has not proven any of these benefits. In many cases research has shown the opposite effect: infection, increased pain, increase incidence of 3rd and 4th degree vaginal lacerations, longer healing and discomfort and increased discomfort upon the resumption of sexual intercourse. Henci Goer, in her book Obstetric Myths versus Research Realities, states: "routine or prophylactic episiotomy to prevent perineal tears (as opposed to episiotomy for specific indication such as fetal distress) is the quintessential example of an obstetrical procedure that persists despite a total lack of evidence for it and a considerable body of evidence against it". In fact, Goer states that every study has found that deep tears are almost exclusively extensions of Episiotomies." (Goer, Henci, Obstetric Myths Versus Research Realities)

A recent article published in the Wall Street Journal (March 30, 2000) offers an excellent account of the history of episiotomy as well as a survey of recent research decrying the procedure as excessive. Performed on millions of American women for its supposed benefits in spite of an outstanding series of studies which point to the lack of scientific evidence to justify its continue use. A 1982 review of 350 books and articles on episiotomy by Stephen Thacker of the U.S. Center for Disease Control and Prevention concludes that arguments in favor of routine cutting to prevent lacerations, protecting pelvic muscle tone and preserving sexual function, do not withstand scientific scrutiny.
Research and nurse-midwife at UCSF, Judith Bisthop states, "The indications for episiotomy-sparing the fetal head and the maternal bottom-didn’t hold water, ...what helps, states midwife Elsa Heros, is not rushing the birth, just letting the baby’s head do the stretching and patiently waiting there with Mom." (Wall Street Journal, 3/30, 2000)

In conclusion, the studies reported summarize the health hazards associated with episiotomy and its overuse. The following are some preventative measures:

Good nutrition (healthy skin stretches more easily)
Kegels (exercise for your pelvic floor muscles
Prenatal discussion with your care provider about episiotomy
Prenatal Perineal Massage
A slowed second state (controlled pushing)
Warm compresses, perineal massage and support during delivery.

Our HypnoBirthing childbirth education class will help you with the practice of each of the preventative measures.
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