In the first part of this series, we saw how an episiotomy (a cut on the vaginal opening during the phase of pushing) does not need to run frequently because there is a risk that it will hurt the mother outweigh any possible benefits for her and her baby. In fact, there is no use for the baby at all, unless there is a real need for the baby to be born soon as it is in trouble. So, why this has become part of routine practice in some hospitals? Let’s look at a little history of this intervention. (Do not forget to check out the third part, which considers alternatives episiotomy).
Prior to the invention of sewing, doctors and midwives around the world have used the simple ways to prevent perineal damage, such as lubrication of the perineum and the slow birth of the head. In cases where there has been a split, the woman simply rested with bandaged legs until the area is healed naturally.
1700’s a small number of doctors practicing in Europe episiotomy in rare circumstances, and in the early 20th century, the practice was ‘rediscovered’ in the United States. Doctors at the time were eager to improve field operations, a new birth. They were careful when it comes to slow ongoings of the head, which of course prevents tearing, because they believed that longer delivery lead to brain damage and injuries babies. They even compared the normal delivery with crushing baby’s head on the door. They also speculated that the surgical incision heals better than natural cleavage, which can be jagged. Therefore, it is recommended forceps delivery and episiotomy for all mothers. Based on these manipulations fear, both practices quickly spread throughout the United States 1940 and Europe in the 1960s. However, research has been conducted to see whether episiotomy actually reduces the incidence of brain damage or improve healing compared to tearing. Research has shown that none of them true.
In the UK, the procedure is dijelimično expanding the policy of closing small maternity units in favor of larger, centralized hospitals and therefore greater pressure staff that a woman goes through the system as quickly as possible. Shorter periods are considered appropriate for delivery. To ensure that women are born within these artificial deadlines, and contractions cause or accelerate, and women are strongly encouraged to push, and episiotomy was performed to make sure that the baby is born as quickly as possible.
This shows that this intervention is associated with other hospital practices at birth, especially in the stage of pushing. These practices have an impact on why you still need to use an episiotomy. For example, directed pushing, when his mother says he is being pushed, and often includes the fact that he held his breath, combined to lie on his back and applying pressure fundalnog during pushing (where a doctor or nurse puts pressure on your stomach and push the baby out ) can make too much pressure on the perineum, which means it is harder to tear possible (and thus episiotomies perhaps justified). All of these interventions have been made to accelerate the phase pushing. This topic will hopefully be the topic of the next post.
By the late 1970s, most hospitals had a policy on mandatory episiotomy for all first-time mothers. Many women are not like that and they called for more research on the so-called benefits of these practices. In the 1980s, an organization that protects the rights of pregnant women collected funds, so that the women who had an episiotomy against their will could sue their doctors. Thanks to this and the results of several studies that have given weight to women who refuse this practice, episiotomy is Poštak rare in the UK and other western countries. However, it is still quite common in America, Latin America, India, Katra and the Balkan region.
References:
The History of Hemorrhoids in the UK http://www.aims.org.uk/OccasionalPapers/historyEpisiotomyInTheUK.pdf
John Scott, Hemorrhoids and Vaginal Trauma 2005 http://www.utilis.net/Morning%20Topics/Obstetrics/Epis,%20vaginal%20trauma.pdf
