Obstetric Lie #81 - An Episiotomy is Better than a Tear
“Isn’t it simply mind boggling that somebody would say that an episiotomy (a cut, with scissors) into a mother’s vagina is BETTER than a natural tear? Who made that up? Obviously not somebody who has actually HAD their vagina cut with scissors.
Oh, but people DO say it. “A straight cut is better than a jagged tear.” “An episiotomy is so much easier to stitch up than a tear.” “Babies are so big, you are going to tear anyway, might as well make it faster.”
Ahh….to be a woman in this day and age and to accept so readily the inevitability of our own body’s failure. Well, I for one don’t accept it. It defies logic to say that it is better to cut a stretchable part of the body than to simply let it tear (or even better- NOT TEAR! Yes, this too can happen!)”This brings up something. Last year we we’re learning how to sew an episiotomy wound, because as future midwives we have to know how to do it.
The professor who was with us used the same words: An episiotomy is better than a tear.
We were practicing on models, and when I finished with my work, I called the professor (who is also a doctor and works in the delivery room) to see if I did well.
She looked at it and said: Well, it’s okay, but it doesn’t have to be so nice. We sew face wounds like that, and a vagina really doesn’t have to be sewed up so nice.
I almost threw up there. How can a doctor say something like that? How can any kind - not only vaginal wound be sewed up too nice?
I had a lot of patients, and only some of them had an episiotomy, but it was really necessary and they all agreed with it. And none of my patients, who didn’t have an episiotomy, had a tear. None.
Makes me want to go there, find that doctor and scream at her.
This is kind of weird to hear; as someone currently 8 months pregnant, I’ve been told over and over by midwives - and have read in both baby books and parenting websites - that tearing is demonstrably better than an episiotomy, because a sharp cut won’t heal as easily. Is it possible this is a dissonance between American practice and practice elsewhere? Antenatal care in the UK is both free and heavily midwife-lead: all my regular checks have been conducted by midwives, the standard antenatal classes have been lead by midwives, I’ll be primarily cared for by midwives during labour, and once the kidlet is born, a midwife will visit me at home to make sure I’m coping, that the baby is well and that I’m not struggling to breastfeed. A doctor will probably be involved at some point during the actual birth, but in all probability, they won’t be my primary physician unless something goes wrong (which I obviously hope it doesn’t). But the point being, according to every single resource I’ve encountered thus far - all of which have been produced in either the UK or Australia - tearing has been cited as preferable to episiotomy because of both the reduced healing time and the fact that less damage is always better than more. So, yeah. Cultural differences within medicine, possibly? Or maybe I’ve just been surrounded by particularly good midwives.
The U.S. loves medical interventions for reasons that have nothing to do with health care. My first pregnancy was largely spent in Germany with a German OB & I had a huge culture shock when I came back to the U.S. Everything I had been told about pregnancy while I was abroad was rooted in it being a natural process requiring minimal intervention. Only in the U.S. was pregnancy a sickness that required treatment.
