If you're pregnant and have dutifully read What To Expect When You're Expecting, you're probably familiar with the term "episiotomy." Some women are, understandably, anxious that in the middle of labor chaos they won't know if it's being done to them. To hopefully ease some minds, I set about to answer the question: "How will I know if my doctor is doing an episiotomy?" After all, the chaos of labor and delivery doesn't negate the absolutely unwavering need for consent.
For those who may not be familiar, Baby Center defines an episiotomy as, "a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening." According to the Mayo Clinic, episiotomies used to be a fairly routine part of childbirth. However, as medical science developed researched and doctors alike realized that episiotomies should only be recommended in specific cases, including the following:
- Extensive vaginal tearing appears likely
- Your baby is in an abnormal position
- Your baby is large (fetal macrosomia)
- Your baby needs to be delivered quickly
The Mayo Clinic says birthing women who are not under general anesthesia (i.e. during a C-section) will have the area numbed by their OB-GYN prior to the episiotomy being performed. So though you should not feel the episiotomy incision as your doctor is making it, the fact that they've numbed you, or are taking out scissors, may indicate their intention to perform the cut. As with any medical intervention, legally the doctor does have to get your consent before performing an episiotomy.
Sadly, a quick review of a few pregnancy and postpartum online message boards reveal that not all doctors follow informed consent for episiotomies during childbirth. Yahoo! News reported the 2015 case of Kimberly Tubin, in which the mom sued her obstetrician Alex Abbassi for a forced episiotomy. This story, sadly, illustrates this disturbing practice that many women in labor have experienced first hand.
To avoid an episiotomy, Parenting advises talking to your practitioner well before your birthing day, so that you can establish a set of guidelines and make your wishes known prior to the potential chaos of labor and delivery. In fact, Parenting makes a point of advising soon-to-be moms to ask about their OB-GYN's individual, as well as the hospital's, rate of episiotomies. Tell your care provider what you want and don't want in terms of an episiotomy and if they don't share your views or seem hesitant find another provider.
If you think your doctor may have given you an episiotomy without your consent some telltale signs in the moment may be the snipping sound of scissors, or your baby exiting the birth canal quicker than what would have been logical have an episiotomy not been performed.
Afterwards, what may signal an episiotomy is the need to stitch with no conversation about you having torn or the degree of any tears, or finding stitches on your perineum. When in doubt ask questions, and if you aren't certain you'll be able to advocate for yourself during childbirth, consider having a support person with you who knows your wishes and will advocate on your behalf.