Avoiding Episiotomy During Childbirth

I coached as my wife was delivering our third child. She was at the final phase of delivery where the last few pushes would result in the birth of our second daughter. As the crown of our daughter's head protruded slightly from the very end of the birth canal, my wife's obstetrician yelled, "Stop! Don't push..."

He quickly positioned a hypodermic needle and injected anesthetic into a section of my wife's perineal tissue - the skin between the vagina and the anus. Next he grabbed a scalpel and carefully addressed the freshly anesthetized area. The attending nurse and I instinctively wheeled our heads to the side so that our eyes could not see what happened next. "I never watch this part," she told me, as the doctor quickly performed a simple procedure known as an episiotomy. Our daughter was born minutes later. As mother and daughter were meeting face-to-face for the very first time, the doctor was busy stitching the incision created during the episiotomy.

The idea behind performing an episiotomy is twofold. The first reason is concern for the baby. Passing through the vaginal canal is the most stressful time for a baby experiencing a traditional vaginal birth. Cutting the perineal tissue creates a wider opening so that the baby can slip through more easily. The second reason is, in theory, to prevent out-of-control tearing of the mother's perineal tissue. The idea is that, by making an incision, the area affected by cutting or tearing is controlled to a certain extent by the attending physician. The problem is that not all mothers experience tearing, so the laceration can be unnecessary.

According to an article by Salynn Boyles published on WebMD (http://my.webmd.com/content/article/110/109783.htm), The Journal of the American Medical Association (Vol. 293 No. 17, May 4, 2005) reports that researchers screened nearly 1,000 medical resources published in the past 60 years looking for data measuring the effectiveness of the procedure. Data from twenty-six articles contained relevant content and were aggregated to form conclusions.

The article reported that there was "fair to good" evidence that the results of routine episiotomy were not advantageous over the results of those with restrictive use of episiotomy. In cases where episiotomy was performed routinely, the severity of the laceration, the degree of pain suffered, and the amount of medication needed to treat was no better than for cases where episiotomy was not routinely performed.

Though most of the individuals were not followed late into life, relevant studies have shown no benefit from episiotomy for the prevention of urinary incontinence or pelvic floor muscle relaxation. Studies have also shown that "impaired sexual function - pain with intercourse - was more common among women" who had the procedure. A report published in the British Medical Journal in January of 2000 reported that women who received episiotomies during delivery had a significantly higher incidence of anal incontinence - the inability to control bowel movements and gas - than their counterparts who did not receive the procedure.

At best episiotomy is something no one wants to observe; at worst it can cause pain, lengthen the time it would normally take for a couple to resume sexual relations, and cause anal incontinence. The ideal situation would be to not only avoid episiotomy, but also to avoid tearing.

Informed mothers are learning more about this subject and taking the time to speak with their obstetricians about it, well in advance of their scheduled birthing date. They are adopting a strategy that includes special exercises using a device called EPI·NO. The EPI·NO is a soft balloon-like device that is inserted into the vaginal opening and gently filled with air to a specific pressure.

As the balloon is inflated the tissues are gently stretched. The pressure is then maintained for a period of time so that the tissues can adjust to the new opening. Daily the amount of air is increased slightly so that the vaginal opening is gently prepared to receive the baby's head. The end result is that the tissues are not only better prepared for the birthing process, but - because the tissues are not suddenly and violently stretched - the tissues more readily return to their prior state.

The philosophy is not new. In fact, there exists an age-old African custom by which an expectant mother gently inserts a calabash or gourd into the vaginal opening, to manually stretch the pelvic floor muscles and the perineal tissues. This process is still in use today in many parts of Africa. Modern science provides us with knowledge and materials that perform a similar function, but in a safer and more sterile way.

Unlike the calabash or gourd, the EPI·NO can be used not only to prepare the pelvic floor muscles and perineal tissues for birth, it can also be used to regenerate the tissues through post-partum exercises. Approximately three to six weeks following childbirth (ask your OB/GYN when to begin), a mother can begin once again to use the EPI·NO.

By clenching the pelvic floor muscles - a process known as a "kegel exercise" - the new mother will see the pressure on the EPI·NO gauge rise. This is called "bio feedback" and helps to inform you that your pelvic muscle exercises are being done correctly and to track your progress as muscle strength returns. Expectant mothers can experience mild to severe anxiety as childbirth approaches. Using EPI·NO a few weeks in advance of childbirth can help to reduce this anxiety.

Clinical studies have shown that using EPI·NO will:

• Reduce the incidence of elective episiotomy
• Reduce the incidence of perineal tissue tearing
• Increase APGAR scores (measuring the overall health condition of the newborn baby)
• Decrease the need for certain drugs during childbirth
• Reduce anxiety for the mother

"My daughter was born after 12 hours of labor without problems and spontaneously without cut or tear, thanks to the training with the EPI·NO and to perineum massage. But the interesting thing about it was that, during the phase of the passage of the baby's head, the thought came to me: you know this feeling, you have managed it before! Instinctively I knew what was happening and, above all, in which direction I should press. (Of course, during the training I did not press, but was conscious of the direction...) In addition, I cannot forget that I was able to practice the "letting go" in the pelvic floor beforehand and thus, was far less frightened before the birth ? "

"I just made it to the delivery table, and the serious business began, 3 pressing pains and my son was there! No perineum cut, no tear, just a small scratch on the left labium and my baby is perfectly healthy. He was born just 1 ½ hours after entering the clinic! And he was my first child! I began with EPI·NO, as you recommended, [three weeks prior to the due date] and finally achieved a distension of 9.5 cm in diameter. On the basis of this experience, I can only recommend your EPI·NO to other women, and am actually doing just this ... "

"The birth was very quick (2½ hours). I had a very short expulsion phase (approximately 15 minutes) and gave birth with an uninjured perineum. I consider these factors to be due to the EPI·NO. ... I think that without EPI·NO there would definitely have been a perineum injury, because when practicing the exercises one senses the progress and how the tissue becomes gradually more extensible. The handling of the instrument is easy. All in all I can most warmly recommend the EPI·NO ... "

More information about EPI·NO can be found by visiting the "Avoid Episiotomy" website (http://www.avoidepisiotomy.com).

Michael Callen is the author of the Weekly Weightloss Tips Newsletter (http://www.weeklyweightlosstips.com) and the Chief Technology Officer for WellnessPartners.com (http://www.WellnessPartners.com), an online retailer of dozens of health and wellness products such as conjugated linoleic acid (CLA), r+ alpha lipoic acid (R+ ALA), and green tea extract.