So what IS a perineum? The female perineum is the region between the vagina and the rectum. It consists of layers of skin, mucosa and muscle. This is the area, during childbirth that is most talked about when it comes to labor trauma/lacerations.
It seems like perineal trauma may be a big concern for many women, for good reason. I mean, no one wants vaginal trauma, EVER.
One of the most common questions I get asked is, “does every woman ‘tear’ down there?”
The answer, no, not every woman will have lacerations from birth. Spontaneous lacerations that occur during birth are not always controllable, but there are certain techniques that can help slow down the birth of the baby’s head, and allow the stretching of the perineum to prevent injury, including “perineal massage, warm compresses and a “hands on” guarding of the perineum.” (World Health Organization, 2018)
The next question is almost always, “is it true everyone gets an episiotomy?”
The answer again, NO.
Lets take a step back... What IS an episiotomy? An episiotomy is a “surgical incision” of the perineum and vaginal wall done by an obstetrician during the last part of the second stage of labor (*translation: as the head of your baby is crowning). The purpose of this incision is to create more room for a safe delivery of your baby. Like any surgical incision, episiotomies should be performed under local anesthesia... like the shots the dentist gives to numb your mouth, only its your OB and your perineum.
While there are many reasons to have an episiotomy, not every woman needs one and not every woman will have one.
It used to be common practice for obstetricians to perform episiotomies routinely because they thought it would help control spontaneous perineal lacerations from extending to the rectum (third and 4th degree lacerations), new evidence has shown that episiotomies should be performed only when deemed absolutely necessary and should be decided by the obstetrician.
In July of 2016, The American College of Obstetricians and Gynecologists (a professional organization that advocates for the highest standards of care, continuing education, and awareness of women’s health care issues) released a practice bulletin that strongly recommends certain prophylactic practices to reduce dramatic lacerations that extend to the rectum and prevent anal sphincter lacerations. These practices include NOT performing episiotomies routinely, applying warm packs to the perineum during pushing, and performing perineal massage in the second stage of labor to reduce 3rd and 4th degree lacerations.
While healthcare is continuously evolving to make childbirth a pleasant experience, and physicians should always strive to administer the highest standard of care, I highly encourage you as a patient, the significant other, or the support person to talk with your obstetrician about episiotomies, their practices, express your concerns, and have an open conversation to create a plan for your delivery.
Big Hugs & Belly rubs.
references
“WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience.” World Health, World Health Organization, 2018, www.who.int/reproductivehealth/publications/ intrapartum-care-guidelines/en/.
“Women's Health Care Physicians.” Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin - ACOG, June 2016, www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Can-Prevent- and-Manage-Obstetric-Lacerations.