Episiotomy is a medical procedure that consists of the incision (cut) of the pelvic floor (perineum) – a set of muscles and ligaments founded at the base of the pelvis, passing through the urethra, vagina and anus and allowing the support of the bladder, uterus and intestines – of the woman when she is in labor. Its aim is to make it easier and faster for the baby. Evidence has shown that this procedure, in addition to being invasive and painful, can harm women’s health and well-being.
In Portugal, episiotomies are performed in more than 70% of births. This number makes us speak of routine episiotomy, that is, a procedure performed as usual practice and not as an urgent and specific measure.
The high number of episiotomies in Portugal aims not only to avoid 3rd and 4th degree lacerations (commonly called tears and which are rare) but also to speed up the baby’s birth. Talk about this topic necessarily implies talking about the birth position. And despite the lack of funding for studies on the subject, it is known that the mandatory horizontal position of women in labor in Portuguese hospitals is a reality and that this is not beneficial for most births.
The woman needs to have freedom of movement and choose the position that naturally causes less pain and therefore benefits the baby’s spontaneous birth with minimal lacerations, which heal well without any harmful consequences. Getting up and moving around may help speed dilation by increasing blood flow. This is because the weight of the baby applies pressure to the cervix.
Childbirth is a natural and physiological process that can take several hours and even days and includes the phases of dilatation, expulsion and delivery of the placenta. Episiotomy is often a procedure that follows others already suggested or performed for the woman at the time dilation, such as the chemical induction of oxytocin that causes and accelerates uterine contractions. These doses of oxytocin cause pain and because it’s not natural oxitocyn it prevents other hormones to take place and ease the pain which then compromises natural labor. The pain may lead the woman to be in a vulnerable situation and to accept being subjected to unjustifiable and possibly unnecessary procedures, if the normal course of childbirth was respected.
Episiotomy contributes to the weakening of a woman’s muscle tissue and to problems related to urinary incontinence, pain and injuries. And, at the limit, it can be considered a mild form of female genital mutilation.
However, of course, there are times when certain invasive procedures are necessary and save lives, episiotomy can save both mom and baby’s life, but it’s a harmful procedure when done routinely.