The Episiotomy Debate Update

The Episiotomy Cut: Debate 2012: In 1935 Aldridge and Watson published their theory that performing an episiotomy would protect the mother’s pelvic muscles. They felt that all sorts of protection would be conferred, including prevention of prolapsed uterus. By the 21st century obstetricians were looking at all the factors leading to bladder incontinence and weakness of the pelvic floor muscles, and it was hotly debated as to whether these episiotomy cuts would be helpful or harmful. The subject is complicated by the fact that women have some bladder dysfunction, and prolapse, immediately after delivery that resolves relatively quickly. The dysfunction immediately after delivery probably comes from temporary weakness or paralysis of nerves of this area, secondary to the baby’s head pounding against the pelvic floor and it’s muscles. In a study published in Obstetrics & Gynecology in 2012 a group of researchers  from the Johns Hopkins School of Medicine looked at women 5 and 10 years after their deliveries to determine how they fared. Specifically this study was interested in “whether a woman tore” her vaginal area in the process of birthing. And they asked in the subsequent years of a woman had incontinence, overactive bladder, anal weakness and prolapse (dropping) of the bladder. They looked at whether a delivery had forceps or a cut or just had a tear in the process of delivery. And in fact they couldn’t find any association between the pelvic complaints or whether the patient had an episiotomy. Actually having delivered by forceps, or if you have had a tear, the pelvic floor is worse. Women with multiple tears were actually worse off, so if you had a tear in one delivery, you need to think about ways to avoid this in other deliveries. Other causes of potential injury are many. Just having a birth through the vagina can lead to more pelvic floor dysfunction. Larger babies and longer times in the second stage can cause problems. So, ‘bottom line’ is how do we protect the pelvic floor.  Oddly either choosing to have no children, fewer children, or no vaginal births (elective c-section) do all work, but aren’t reasonable solutions for moms to be. Good nutrition so that your muscles are well developed and not weak, avoid toxins (caffeine, cigarette smoke), normalize weight gain (so babe is normal sized too!), and protect nerve function by not being diabetic. Once it comes to birthing, let your obstetrician or midwife decide how to effectively shorten the second stage of labor , and if you need an episiotomy for the baby, it’s not going to harm the pelvic floor.

Comments

  1. Very informative article. I had a tear after my first delivery, and then on top of that I have an overactive bladder. I finally decided to find a urologist in NYC and he has helped me so much. After my second delivery, I did not tear and my muscles have not been stronger.

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  2. Urologists, urogynecologists, and gynecologists all can offer women therapeutic options for the treatment of pelvic floor injuries. What is important for women to know is they should bring these issues to the attention of their health care provider so that they can get properly evaluated and treated. One current interest of ours is the concept of improved pelvic floor blood flow and oxygenation. Women with abnormal nutrition that leads to plaque build up are more susceptible to chronic bladder problems that are not as treatable.

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