CESAREAN SECTION OR VAGINAL DELIVERY WITH EPISIOTOMY?

Two years ago, I met my wife and I, at a birthday party, a mother with whom we ended up talking about children, children, second children and pregnancies. We ended up explaining that we had planned to have a second child and she confessed that no, that she would not have more because she did not seem able to return to experience like the one she had lived.

He explained it clearly afflicted, crestfallen, giving detours, showing that it was an issue that still had a latent, emotional scar difficult to overcome, especially when a physical scar reminds him every day of the time of his birth.

“I had an episiotomy, but they opened me whole”He explained to us. I had always been a defender of vaginal delivery before cesarean delivery (and I still am), however, on this occasion, I ended up thinking to myself that, to make you a disgrace in your sex, you better have a C-section (and that the second carries more risks).

Better vaginal delivery than caesarean section

WHO recommends that caesarean section rates do not exceed 15% of deliveries and yet about 22% are being carried out in public hospitals and around 34% in private centers.

This difference causes many mothers who end up giving birth by caesarean section to wonder if it was necessary, if their birth would have been different if they had touched another professional, that other protocols had been followed or that they had given time for the childbirth continued its course.

And it is this difference that makes a large part of the population, usually the part that is most informed about it (the one with less information is usually in a hurry: “there is no right, they had twelve hours of delivery, so that would have had a C-section ”), prefer vaginal delivery over C-section and fight, as long as possible, so that C-sections are used only when there is a real medical need and not as a measure to avoid complaints.

Vaginal birth is not the same as natural birth

But all that glitters is not gold and giving birth vaginally does not mean you had a natural birth, with minimal intervention, since episiotomy rates in Spain are very high.

WHO has reported that Ideally, 10-20% of episiotomies in labor should not be exceeded. and some countries are trying to follow these directions. Sweden, for example, has a percentage of episiotomies of 6%, Holland of 8%, United Kingdom of 13%, France of 70% and 90% Spain.

This makes women who struggle to have a childbirth as they imagine, by the "big door" (understanding the "back door" as a caesarean section), they find a reality almost as traumatic and sometimes even worse, than the same caesarean section : a cut in sex (aka episiotomy).

Why I say "cut in sex" and not "cut in the perineum"

I suppose you will have noticed that I define episiotomy as a "cut in sex." I could say perineum, vagina, labia majora, labia minora or something that sounds lighter, more blurred and scattered, more scientific, but I like to say sex because it seems more crude and more real.

The vagina is not just the place where babies come out, however, at the time a woman is going to give birth, it seems that few people remember it and even fewer people think that after giving birth, the mother continues being a woman and a woman with her sex hurt and healed, with discomfort to have sex and with the scar reminding her from time to time that one day someone hurt her in her most sensitive area can suffer a psychological injury much worse than the physical.

If we gave birth to men

Oh my friend, if we gave birth to men Another rooster. Just thinking that someone could cut my genitals gets goosebumps. Just thinking that someone could do it without being necessary unnerves me.

I may be wrong, but I have the feeling (and my own conviction) that if we were the men who had to give birth, this kind of cuts would not be made so lightly.

In my view, the episiotomy has become another of the tools of submission that the healthcare world uses on the patient and, beyond that, that the man uses on the woman: “Yes, you are a woman, you want to be the same , however, I have the power to cut your sex and rebuild it. ”

I know how bad this sounds, but it is that seeing the scientific evidence, there seems to be no other possible reason for so many episiotomies to continue.

But if it wasn't for the episiotomy, my birth would have gone wrong ...

A Cochrane review of six studies (which you can read here) about episiotomy concludes the following:

The restrictive use of episiotomy apparently has benefits compared to the routine practice of episiotomy. There is less posterior perineal trauma, less need for sutures and fewer complications, there are no differences with respect to most of the measures taken to control pain and severe perineal or vaginal trauma. However, with the restrictive use of episiotomy, there was an increased risk of anterior perineal trauma.

That is restricting the use of episiotomy has many benefits and few disadvantages.

This does not mean that it is always unnecessary, since it is possible that the episiotomy is useful and inevitable in some deliveries (in the 10-20% established by WHO), since nature is wise, but not infallible.

However, observing that there are countries that are having such low rates as the Netherlands or Sweden (8% and 6% respectively) is the irrefutable proof that 90% of episiotomies in our country is a denigrating, unnecessary and could be considered a genital mutilation.

Female genital mutilation?

Dr. Wagner, who was director of the maternal and child health department of the WHO declared a while ago that, given that the majority of episiotomies performed in our country were unnecessary, the practice should be labeled as female genital mutilation.

It sounds even stronger and exaggerated than my phrase "sex cut", however it must be borne in mind that Spain is not the center of the universe and that, just as here we see denigrating the female genital mutilation that takes place in some African countries, a society in which the deliveries are mostly vaginal and mostly natural, with little intervention and therefore with few episiotomies you will see as an excess and as a symptom of backwardness and lack of culture in a country like ours in which the majority of women mothers have vaginal cuts without need.