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Three in four women who have had an episiotomy say they have suffered from it
According to the survey of the Inter-associative collective of birth users (Ciane) *, three out of four women who have had an episiotomy say they have suffered from it. The numerous testimonies collected speak indeed of “problem of cicatrization”, of “physical and psychological pain”, some even confiding their feeling of “having been mutilated”. A practice that could soon fall under the exception. In any case, it is now in sharp decline, with a national rate of 30%, or a third of vaginal deliveries, against nearly 50% eight years ago. A big step forward for future mothers!
Since the 70s, this surgical incision has been commonplace. In some birth rooms, it was even the most frequent technical gesture after the section of the umbilical cord. During birth, the baby’s head presses hard on the perineum, which then stretches as far as possible to let the child slip out. And at the time, to avoid a serious tear, one methodically incised, thinking thus to prevent a future urinary incontinence. It was not until the early 90s and pressure from women’s associations to see this practice called into question. International scientific studies are launched. All conclude that there is no benefit in performing an episiotomy systematically. There are no more serious tears. Episiotomy should therefore be reserved for a few rare indications, such as a short perineum, a suffering baby whose release must be speeded up… Several countries are aligning themselves quickly. In France, it was not until 2005 and the recommendations of the College of French Gynecologists and Obstetricians (CNGOF), which asked maternity medical teams to sheath their scalpels. Objective: reduce the episiotomy rate to 30%. Bet won today! However, in detail, the Ciane investigation shows that there is still a lot to do.
The risk of episiotomy varies from 1 to 50 depending on the maternity ward
This overall rate of 30% hides large disparities. Women are three times more likely to have an episiotomy at their first childbirth than at subsequent deliveries. But above all, the survey points to significant differences between establishments. In some of them, the episiotomy rate still greatly exceeds 50%, while others, as at the Besançon CHRU (Doubs), have a rate of 0,8% in 2012. Prof. Didier Riethmuller, the boss of this level 3 maternity hospital offers an explanation: “It is a question of service policy and team motivation. “And to add in the form of a joke:” In order not to cut, it is enough just not to take the scissors! But for Ciane, the use of episiotomy can no longer remain subject to the goodwill of the teams. Regretting that these figures are not published by all maternities, he asks the public authorities to enforce “a minimum requirement of transparency”, to better inform women and encourage establishments to improve their practices.
Another result of this study, future mothers who gave birth in a physiological space, a natural room or a birthing center, less medicalized places that do not use an epidural for example, record a lower episiotomy rate : 31% for women who give birth to their first child (first-time mother) against 47% for the average of establishments. It should be noted, however, that the recruitment of these women excludes high-risk pregnancies and that here, the medical staff are undoubtedly more aware of the limited indications for episiotomy. Another interesting figure is the rate of episiotomies in the case of forceps and suction cups, useful instruments to help the baby come out more quickly. Today it is 69% whereas more than eight years ago it reached 90%! An encouraging result which could be explained by the increased use of the suction cup, less traumatic for the perineum.
The Ciane survey also looks at the impact of freedom of position during childbirth.. Today, 6 out of 10 women can choose their position during labor and a third at the time of expulsion. This freedom of movement would also be associated with a lower rate of episiotomy: only a third of first-time mothers who were able to move were entitled to it, whereas they are more than half if they remained immobile. But there, Professor Riethmuller of the CHRU Besançon warns against a behavioral bias. “The teams that promote these practices are in the process of demedicalization and therefore do fewer episiotomies. “In short, on the freedom of position, it remains very measured:” It can, in certain cases, cause severe perineal lesions, even postpartum hemorrhages. You have to accept it on a case-by-case basis. “
To discover in video: How to avoid episiotomy?
In video: How to avoid episiotomy?
10% episiotomies, this is the objective set by the associations
In the end, the majority of women today feel that they are better informed by health professionals about episiotomy, even if in 85% of cases, consent is not requested. A figure that makes user associations jump, which recall the Kouchner law on patients’ rights. “Often you have to react very quickly. And faced with an emergency situation, we must make a decision in the second ”, argues Professor Riethmuller. This is why it rather advocates information upstream, during pregnancy monitoring. The patient can, for example, include in her birth plan her desire not to undergo an episiotomy, except in a medical emergency, of course. Despite some reservations, associations of birth users have noted a series of progress and today want to go even further by setting a new goal for medical teams: 10% episiotomies. A country like Sweden, for example, has reached less than 6%! ” But let’s not go too fast ! It is better to focus our efforts first on harmonizing practices in order to reduce the gaps between maternity hospitals, ”explains Prof. Philippe Deruelle, Secretary General of the CNGOF. And Professor Riethmuller, the good student in the class, added: “Rather than coercing, we have to convince. We will get there, I’m sure, but step by step. In the meantime, expectant mothers can find out more by consulting the non-exhaustive list of maternity hospitals with an episium rate below 30%. It is published as an appendix to the Ciane survey. You can also call the establishments to find out about their practices.
* This survey was carried out on a total of 9 vaginal deliveries, including 783 since 6.