Episiotomies
Though up-to-date medical research advises against routine preventative episiotomies, the procedure is still widely practiced at many hospitals. The ACOG estimates that up to ninety percent of first-time births in hospitals will result in the woman having an episiotomy. Home births and births in birthing centers are far less likely to involve episiotomies; in these situations the rate is ten to fifteen percent. The procedure first became routine in the '30s and '50s when the heavy anesthesia given to women during childbirth made effective pushing difficult. Episiotomies were given to fit forceps in and lift the baby out.
While episiotomies are intended to avoid spontaneous tears, it is now thought that they may actually increase the instance of severe tearing. Critics cite risks such as severe postpartum pain, infections and difficulty during intercourse. Experienced midwives and many obstetricians say there are many things you can do to lessen the potential need for an episiotomy, such as controlled pushing, regular Kegel exercises and talking to your doctor about not wanting one. Some midwives advocate perineal massage as a preventative, others say that this isn't necessary as long as other measures are taken during crowning. Finally, experts say that while routine episiotomies are not a good idea, there are situations in which the procedure can be necessary.
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