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24th November 2015

Your body, your decision: mums want control when it comes to childbirth

Giving birth is one of the most personal things a woman can experience. Yet in many developed countries, soon-to-be mums often find themselves in a room full of virtual strangers when it’s time to start pushing.

Not only are these doctors, nurses and midwives at liberty to examine and probe “down there”; they also have the power to decide whether cutting the area between the vagina and the anus (perineum) to make more space for the baby, a procedural called an episiotomy, is medically necessary.

Presumably most women would prefer to leave the hospital without being stitched up on this very sensitive part of their body. But many women, such as Myrin from London, are also quite open to the medical intervention, as long as they feel they have a choice and it’s in the best interest of mum and baby. The mum of three girls had her first daughter in Australia, which generally views childbirth as a natural event rather than a medical one. “It was a 26-hour ordeal and because the baby was sucking her thumb, her arm and shoulder were stuck. The doctor said that I could stay there for another couple of hours or we could do an episiotomy and get it done. It wasn’t an emergency situation but the baby was ready. The ventouse was helping but she still had her hand in her mouth, so I decided to have the episiotomy. I went home with six stitches and very little pain or issues with healing,” says Myrin.

“Everything was going fine. I was in the bath, but then my son’s heartbeat slowed. The midwife rushed me out of the bath and did an episiotomy without asking.”

She adds that the midwife wasn’t on board with her and the doctor’s decision to carry out the episiotomy. Indeed, with so many differing opinions at play, it’s not uncommon for the mum’s birth plan ‒ a written record of what she wants and doesn’t want to happen during her labour ‒ to go by the wayside.

Ingrid, a mum of two from London, knows about this all too well. When having her second child, she had specifically said in her birth plan that she didn’t want an episiotomy. She’d read that the wound from a natural tear healed faster than that of a straight cut made by surgical scissors and was prepared to tear rather than having the procedure.

“Everything was going fine. I was in the bath, but then my son’s heartbeat slowed. The midwife rushed me out of the bath and did an episiotomy without asking. She didn’t sew it very well and I ended up with a large tear, probably facilitated by the episiotomy,” she recalls.Despite what she describes as a “grim” experience, Ingrid wouldn’t go so far as to say that episiotomies are unnecessary. She acknowledges that they’re sometimes needed, for example, if the baby is showing signs of distress or the mum’s health is at risk. “For me it was about being well informed and in control while accepting that if anything went wrong, I had the medical facilities available to me,” she says. “Luckily it was my second birth so I knew what was happening ‒ but I had no say [in the matter].”

A recent article by Hannah Dahlen, Professor of Midwifery at University of Western Sydney, debates whether episiotomy is “just a little snip” or a traumatic and unnecessary procedure. She notes that between 1940 and 1980, episiotomies became routine in the US and, to a lesser extent, in the UK and Australia. “Widespread use of episiotomy was promoted as better facilitating the birth, protecting the baby’s head from trauma and preventing lacerations of the perineum and undue stretching of the pelvic floor,” the author explains. Today episiotomy rates vary across countries and from hospital to hospital.

There will always be different schools of thought about this emotive issue, but for mums it seems that empowerment is the key.