Birth and Babies

An episiotomy is a surgical incision in the perineum (the area of the skin between the vagina and the anus).  It is one of the most common surgical procedures in childbirth and is quite surprising considering that in most cases, they are unnecessary and can do more harm than good.  Episiotomies DO have their place in birth, but only as needed and not routinely.

Episiotomies and tears are measured in degrees.  The most common episiotomy is a 2nd degree, midway between the vagina and anus), and the least common and biggest being a 4th degree tear that extends through the rectum (ouch!).   There are also different types of episiotomies - the midline is the most common (extends directly towards the anus)  and the mediolaterial which is a diagonal cut toward either side of the anus.

Why an episiotomy?

These incisions are cut to enlarge the opening as the baby comes out to deliver a baby quickly or to try and prevent a woman from tearing naturally.  Most commonly claimed ”benefits” are: speedy delivery (in the case where birth is immenent, but the baby must be born quickly due to distress or other complications), it prevents tearing, protects against incontenence, heals easier than tears, and protects against pelvic floor relaxation.  Many women are cut because doctors claim the skin is too tight to stretch over the baby’s head and as a result, tearing is going to happen unless she is cut.  Or the baby “needs” to be delivered quickly because birth is taking too long (when there are no complications or fetal distress - we must remember birth is not a timed event).  In many cases, episiotomies are simply routine procedures that our insurance pays for (or that we pay for out of our own pockets).

Surprisingly, many of the above cited benefits have never been proven true by medical research and many of them are actually false.

Did you know that in study after study, one of the most common risk factors for 3rd and 4th degree tears is an episiotomy, the very procedure used to protect women from large tears!

Our skin becomes more prone to tear when it has already been cut.  So, if you have an episiotomy, your skin will be more likely to rip deeper as it is stretched from the baby’s head crowning.  If women were able to birth their babies nice and slow, in positions that would allow better fetal position and delivery,  with perineal support, the chance of tearing reduces dramatically.  If a tear does occur, in most instances it will be small unless your birth involves forced pushing, instrumental delivery (in which case an episiotomy will be cut), poor positioning and rough handling.

Episiotomies are not without their risks.  The most common risks and side effects reported include infection, increased pain, increase in 3rd and 4th degree vaginal lacerations (an extention from the episiotomy), longer healing times and increase discomfort when intercourse is resumed.

That being said, episiotomies do have their place.  For delivery where instruments are required (forceps, vaccum), an enlarged opening will be required.  In many cases if a quick birth is needed to deliver a baby, getting into a squat can enlarge your pelvic opening to allow that baby more space to flex/extend/rotate his way out of your body.  But if assistance is required, an episiotomy has it’s place to enlarge the opening and allow what needs to be done to be done.

Your position during birth can have a lot to do with tearing…  If your doctor suggests a cut, you might suggest changing position if you are able to, or perineal support to see if that helps things at all.  I know with my daughter, I birthed her in the classical “on your back” position and I did tear slightly delivering my 6 lb. baby.  Then delivering my son at home on hands and knees, my 7lb 5 oz baby was born without so much as a skidmark!  This is very common.

Prenatally, you can do the following to help prevent tearing in the first place: eat a healthy diet (healthy skin stretches more easily), kegals (exercises for the pelvic floor), prenatal perineal massage, slowed second stage (careful pushing), warm compresses, perineal massage and support during delivery.  Reducing the chance of tearing will reduce the possibility that your doctor will suggest an episiotomy to prevent tearing

As I was getting ready to add new categories and start blogging away on a few different topics, my lap top totally died.  It’s not fixable, but luckily, my wonderful step father still had my other laptop at his house that he fixed up for me so I am now back online with a totally reformatted laptop… And a ton of programs to re-install.  So, when the kids are in bed tonight I will finish personalizing my laptop, and hopefully get back to blogging tomorrow!  Just wanted to let you know I didn’t drop off the face of the earth!

What is it?  A pelvic scoring system used to predict how well an induction will go.  Sometimes inductions can fail, especially if the cervix is not favorable.

The Bishop Score evaluates the position of the cervix, the cervical consistency, dilation, effacement and station of the presenting part (baby’s head, usually, or in breech births this would be the bottom).  The higher the score, the more favorable the cervix may be for induction.

Unfavorable conditions include a posterior cervix, with firm consistency, -3 station, 0-30% effaced and 0 cm. dilated.  More favorable conditions would include an anterior cervix that is soft, with -1 station, 60-70% effaced, 3-4 cm dilated or better.

Induction is a medical procedure used to stimulate the start of labor.  In most cases this is used in women who are past their due date, for babies who are expected to be large at birth, or with other complications that require a quick birth of the baby but are not severe enough to require a cesarean delivery.

Induction is not recommended to “plan” a birth date, or for women who are getting impatient waiting on their little one.  As with all medical intervention, induction does carry risks from mild to serious.  Unless medically needed, babies will come when they are ready.  Even the big ones! :-)  There are more natural approaches you can take to help stimulate labor on your own at home, however, none of these techniques will work unless your body is ready to go into labor anyway.

I will post additional details about induction either tomorrow or in a few days.  I’d like to start some categores and blogging on a few topics and turn this blog somewhat into a “childbirth education on the web” type of deal.  It won’t take the place of a good childbirth class, but it will certainly (hopefully?) help someone who is unable to take a class for whatever reason, or just for those who want more info!

I wanted to share with you one of my favorite resources for natural family living including conception, pregnancy, birth and babies at www.mothering.com  They have a wealth of info, including a discussion forum on every possible topic you could think of pertaining to natural family living.  It’s awesome!

More birth ball tips and ideas.

Birth balls are a wonderful tool for laboring. These are the professional slow deflate, latex free varities you sit and rock on - NOT the big toy balls you find in the toy section of your local store!  When using a birth ball, make sure it is properly inflated and that the stopper is in properly (very important!).

When in use, the floor should be free from any objects that could puncture the ball.  Be sure that you practice using the birth ball before labor - it can take a moment or two to get aquainted with it.  Be sure that you have someone close to grab onto if needed, or a counter or bed that you can hold on to for stability.  Always use a chux pad between you and the ball to avoid skin to ball contact (considering the ball will be rolling around on the floor, this is important to keep yourself clean)

What is the birth ball good for?

Slow labors, posterior babies, hands and knees position (lean over the ball, and you avoid putting your weight on your wrists on the floor!  you can also roll back and forth i n this position with ease), supported squat, pelvic rocking, a baby that is still high up, bouncing, rocking, etc.  Birth balls also allow easy access to the womans back for massage, and is an excellent choice for a mom who is being monitored (by electronic fetal monitoring) to maintain an active and upright position next to the bed, without getting tangled on the cords and having to stay bedbound (unless medically necessary).

In my next post, I’ll share more ideas and tips for using birth balls. 

In honor of Earth Day coming up, I thought it might be a good idea to post some ideas that could help you contribute to protecting our earth, that are baby related.