A huge part of women's view is the language used around tearing and
episiotomy and the lack of positive language for womens vagina in birth,
ie capacity to stretch and recover. I see the language around tearing
such as mutilating uncontrolled etc whereas episis are seen as
controlled, neat straight etc. In a society where we trust surgery so
much - just look at the cesarean section rates - episi fits into this.
In classes i teach women to think about the capacity of their vaginas
and perineums in birth and find positive ways of discussing this. I also
talk about tearing along a muscle line as more able to heal well than a
cut through it. I always say it may be easier for me to suture an
episiotomy but I am not the one who has to sit on it and feel it for the
rest of my life - so it should never be about what is good for the
perosn managing the birth (although unfortunalty it most often is). It
is inetresting that people always ask well can I say no, why do they
think someone else has the right to cut into their vaginas when there is
no research to support this as a routine practive!!! Any way I could go
on for ever about this issue...
I am finishing my Phd at the moment and have just cut out a chapter
looking at womens worries around their vaginas in birth and a feminist
discussion around episis etc, I found my other chapters were big enough
and the women in my study didnt really talk much about worrys of tearing.
I wonder why you are having trouble recruiting, i am happy to chat to
you off line about this
it is great to see this type of research being done
Belinda
Alice Morgan wrote:
This is interesting for me. I am currently writing my midwifery
honours thesis on women's views about episiotomy (or trying to at
least, unfortunately I am having great difficulty with participant
recruitment). It's always nice to see more research backing up what I
am saying.
:) Alice (one of the first SA BMid grduate midwives)
From: "leanne wynne" <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] article FYI
Date: Wed, 02 Nov 2005 11:05:02 +1100
Unnecessary episiotomies
Issue 22: 31 Oct 2005
Source: International Journal of Gynecology & Obstetrics 2005; 91: 157-9
Researchers have questioned the continuing widespread use of routine
episiotomy, after finding high rates at some centres in countries in
South America, Asia, and Africa.
Systematic reviews of published trials, including a Cochrane review,
have suggested that episiotomies should not be performed routinely,
because of the associated maternal morbidity.
Some specialists have said that no more than 10 percent of
nulliparous women delivering vaginally should need one, according to
the researchers writing in the latest issue of the International
Journal of Gynecology & Obstetrics.
But their study suggests that episiotomy rates are far higher than
this at some hospitals. The researchers, from Uruguay and the USA,
analyzed data on episiotomy rates for nulliparous and multiparous
women at hospitals in Argentina, Brazil, Bolivia, Chile, the
Democratic Republic of Congo, Ecuador, India, Tibet, Uruguay,
Venezuela, and Zambia.
The hospitals studied (from 1 to 13 per country) were part of the US
National Institute of Child Health and Human Development’s Global
Network for Women’s and Children’s Health Research.
Rates above 90 percent
Reporting their findings, the researchers say that episiotomy rates
among nulliparous women were higher than 90 percent in all countries
except Zambia (6.9 percent).
Episiotomy rates for all vaginal births were higher than 20 percent
in all countries except Zambia, and were as high as 80 percent in
Brazil. The exception, Zambia, was unusual in having a lower rate for
nulliparous women than for all vaginal births. The researchers,
however, caution that the data for Zambia were obtained from only one
hospital.
They also advise against generalizing the findings beyond the centres
studied. However, they say the data “illustrate the widespread use of
routine episiotomy… in contradiction to the evidence questioning its
efficacy.”
Unnecessary episiotomies, the researchers write, increase the risk of
morbidity as indicated by the Cochrane review, including posterior
perineal trauma, the need for suturing the perineal wound, and
healing complications at 7 days.
They conclude: “Strategies should be developed to decrease episiotomy
rates at a global level.”
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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