Sun, 08 Apr 2001

Episiotomy -- myth versus fact

By Injil Abu Bakar

NEW YORK (JP): U.S. official data show that in 99 percent of childbirths in hospitals the routine procedure followed is episiotomy, a surgical act to enlarge the vulval orifice for obstetrical purposes during parturition (the act of giving birth).

When episiotomy is conducted, the perineum area, which is between the vagina and the anus, will be cut to allow greater room for the baby to come out during parturition. Episiotomy is reportedly beneficial as a routine procedure in childbirth in the following respects:

* The wound left by the episiotomy is neat and clean. This wound will heal more easily than the wound resulting from spontaneous tearing which may occur during childbirth;

* episiotomy can prevent possible damage to the brain of the baby because the cut made in the perineum area will lessen the pressure that the head of the baby will have to sustain;

* childbirth will take a shorter time, reducing therefore possible damage to the pelvic area. As the time needed to force the baby out is shorter, the head of the baby will receive less pressure, also minimizing the danger of oxygen shortage and brain damage;

* episiotomy is believed to prevent the external sex organ from sagging, a condition that women would never like to happen to them because it can make their husband complain about the drop in sexual satisfaction;

* episiotomy is also believed to prevent the base of the pelvic cavity from loosening as otherwise it will cause a urine incontinence stress (urinating while laughing or sneezing, protruding of the wall of the large intestines or the uterus bursting towards the vagina.

All these benefits sound reasonable. Unfortunately, the results of research do not corroborate them. In reality, in many cases episiotomy brings about a variety of side effects such as infection, increased pain, a long time required for healing, pain in sexual intercourse and a higher risk of total tear in the perineum area (total tear from the vagina up to the anus).

It is therefore understandable why many parties have called this procedure into question and have even opposed it. Even the American College of Obstetricians and Gynecologists has issued a statement that episiotomy is not absolutely necessary for every childbirth. It is not a routine procedure, the college says.

Nevertheless, episiotomy, first practiced in Ireland in the 1700s, is still conducted in between 15 percent and 90 percent of childbirths in the United States.


Dr. Robert J. Wooley of Minnesota University has reported that the myth of the benefits of episiotomy, almost four centuries old now, cannot be verified. Episiotomy is in reality harmful, especially considering that any surgery entails a side effect.

In the case of episiotomy, there is a tendency that the mother will lose more blood and have a higher risk of sustaining damage to the valve of the anus. Besides, she will feel pain for longer and more seriously. The first random research in North America, pioneered by Dr MC Klein and Dr RJ Gauthier, also arrived at a similar conclusion. The result of this research recommends that episiotomy is conducted only when there is a clear indication that it is really needed.

In principle, adopting episiotomy as a routine procedure in parturition is unwise. This, however, must not be construed as a ban on episiotomy. It will be adopted only when it is absolutely necessary, a condition which very much depends on the elasticity of the perineum tissues.

The condition of this elasticity may be found out only when the process of childbirth has started. The elasticity of perineum tissues differs from one woman to another. Therefore, preventive episiotomy can be adopted only when the elasticity of the perineum tissues has been evaluated.

As a matter of fact, God seems to have designed these perineum tissues to be extended to 8 times their normal size. In other words, the woman has been prepared in advance for childbirth. It follows, therefore, that episiotomy will be adopted only for a minority of women whose perineum is not elastic.

Perineum massage

If episiotomy is needed only in some cases, is there a way to avoid it? If the perineum tissues can be extended to 8 times their normal size, how can this amazing elasticity be utilized? Many things, in fact, can be done to avoid surgery.

It stands to reason why experts maintain that nutrition contributes substantially in this respect because healthy skin tissues will have excellent elasticity. In this case, the most important and interesting thing to do is to massage the perineum area six weeks prior to parturition.

This may sound rather strange and illogical. Think about it for a while and you will agree that one can do amazing things only after serious preparation. Former heavy-weight pugilist, Mike Tyson, for example, had to go through thousands of training sessions before going into the ring. Steffi Graf would remain a mere ordinary tennis player if she had not worked hard to make herself a tennis queen. In the same way, the perineum must be given some exercise to ensure that it will be torn only a little.

It is clear now that this massage will give exercise to the perineum in extending itself. This extension will simulate the natural extension during childbirth. Research shows that if this massage is practiced every day for 6 weeks prior to the D-Day of parturition, the tearing of the uterus passage will be significantly reduced and in some cases there will even be no tearing at all.

If you would like to massage the perineum area, do this:

1. Wash your hands thoroughly. It is advisable that you trim your fingernails first. Then sit in a position of a woman giving birth to a baby, with the two legs bent at the knees and wide open. First apply on your fingers and the perineum area the oil usually used for massaging. Or, you can use some cooking oil or Vitamin E oil.

2 Put the thumb as far as possible into the vagina cavity and then press the perineum area towards the anus. Then move the pressure to the side. Do this until you feel an uncomfortable burning sensation.

3. Maintain the pressure until you feel less of this burning sensation. Then gently massage the base of the vagina, moving from the front to the back.

4. Do this massage every day when your pregnancy enters its 34th week.

The myths about episiotomy are still found today although many researchers have annulled the classical view that episiotomy should be made a routine procedure in parturition. There will come a time when these myths, which we must reflect upon, will no longer hold.

--The writer,, is a general practitioner based in Denpasar, Bali.