According to the latest National perinatal survey performed in 2016, the episiotomy rate in France is today 20%. A figure that is steadily decreasing, the rate was 27% in the previous report dated 2010. This practice, which consists of making an incision in the vaginal wall and the muscles of the perineum to facilitate the birth of the baby is more and more decried. It requires stitches and the recovery is sometimes long and painful. For a long time, it was considered that episiotomy was preferable to a tear, but in recent years, recommendations have changed.
WHO’s position on the issue of episiotomy
On the issue of episiotomy, the World Health Organization is categorical. “Routine episiotomy or its wide use is not recommended for women who give birth spontaneously“, can we read in a report dated 2016. WHO also estimates that in general, whatever the indication, the number of episiotomies should not exceed 10% of deliveries.
The CNGOF (National Council of Obstetricians and Gynecologists of France) adopts a similar position. “The indication for episiotomy during childbirth depends on individual risk factors and obstetric conditions. (…) There is no recognized benefit to the practice of episiotomy in normal childbirth.“, indicates the CNOF which adds that there is also no formal indication to the episiotomy “in breech presentation, twin pregnancy, or to reduce the risk of obstetric lesions of the anal sphincter. “An episiotomy may however be indicated during an instrumental delivery precisely in order to avoid these obstetric sphincter ruptures which are also called LOSA.
Why a tear is ultimately preferable
According to the classification of the WHO and Royal College of Obstetricians and Gynecologists (RCOG), obstetric perineal tears are classified according to 4 degrees of gravity. From the 1st degree when there is a superficial tear to the 4th degree when there is a LOSA and therefore a complete complicated tear. The tear is by nature unpredictable, it is impossible to predict what will be its extent. The episiotomy then appears as a reassuring solution, the doctor makes a clean cut. The problem remains that it is still practiced too systematically.
In his book This is my body (The Iconoclast, 2020), the doctor Martin Winkler warns about the consequences of episiotomy. “It does not prevent tears of the perineum but on the contrary aggravates them: when you cut the skin, it tears more easily. The vulva and the vagina are the same, he writes. Spontaneous tears are often smaller and more superficial than episiotomies. They are easier to repair and heal faster“, further specifies the doctor.
Episiotomy, an act that is sometimes badly experienced
Episiotomy is not a trivial act and is often experienced by women as a real mutilation. “I realized that I had had an episiotomy when the gynecologist started to sew me up. He totally downplayed the act itself and told me he had no choice. Not only did I have terrible pain for over a month, but the impact on my sexuality was considerable.“, remembers Nathalie, mother of a 7-year-old girl. The CNGOF nevertheless insists on the need”explain the indication and obtain the woman’s agreement before performing an episiotomy“, but in fact, many women find themselves faced with a fait accompli.
Same story with Jessica, who gave birth to her second child this summer. “For my first childbirth I had already had an episiotomy which I recovered quickly. The second time, however, I really suffered and the stay in the maternity ward was very marked by severe pain.“, explains the young woman. Aissa also had an episiotomy for the birth of her daughter, who came into the world with the forceps:”I am a nurse so I knew that during an instrumental birth, the episiotomy is almost systematic. Even though I was prepared for it, I experienced it as a rather violent act. Looking at my cock in the mirror afterwards was difficult. Today, 8 months later, everything is back to normal, but women should not be told that episiotomy is nothing. Yes, it is something. We have the right to live it badly, and the right to say it“.
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