Pregnancy / Childbirth

Crotch incision - a necessary procedure or too often?


Crotch incision is a controversial topic, but "on time". According to the World Health Organization, an episiotomy is necessary in about 5-20% of births. The realities of Polish delivery wards are frightening, but it's getting better every year. Let's find out more about the epizotomy ...

What is the crotch incision?

Epiziotomy is a procedure involving the incision of the skin and muscles in the lower reproductive canal. The midwife or doctor cuts the perineum at the top of the spasm when the patient passes and the baby's head presses against the tissues and stretches them. The crotch incision corresponds to the 2nd degree of spontaneous perineal rupture. There are two methods of cutting the perineum. The first is median incisionin which the cutting line leads straight towards the anus (only the muscles of the perineum are cut !!). The second method is used much more often - this is it inclined incision, running towards the sciatic tumors.

When should an episiotomy be used?

In fact indications for an episiotomy are much less than the situations in which it is used. An epizotomy is necessary in the case of large fetal heart rate fluctuations, surgical delivery (that is, labor using ticks or vacuum) in the case of shoulder distortion (this is the situation when, after the birth of the head, the shoulders of the newborn cannot squeeze through the birth canal) or in the case of a large and non-susceptible scar after a previous episiotomy.

In addition, an episiotomy is proposed when giving birth pressing head causes whitening of the skin (this is the symptom preceding the perineal rupture). In this situation, however, each patient should make her own decision and allow the midwife to cut the perineum.

Remember that the new standard of perinatal care prohibits routine crotch incision (also in women giving birth for the first time) and orders to limit the episiotomy to situations requiring this surgery. This standard indicates the need to inform you about the planned surgery and its necessity. You also have the right to refuse the incision.

How to prevent crotch incision?

The main thing is that you she cooperated with the midwife. Tell her, already at the delivery room, that you really care about protecting your perineum. Any midwife, even the most hardened in her views, will take this into account. Tell the midwife that you prepared your crotch for delivery. Secondly, listen to the midwife in the second period of delivery. When the head is born, you will have to push, then the midwife will ask you to stop. Listen to her carefully.

Preparation of the perineum for delivery should begin many weeks before delivery. The sooner the better (it's best to start from the middle of pregnancy). It is very helpful perineal massage.

How to do a perineal massage?

You can use for it baby olives or olive oil (e.g. from olives, wheat germ, almonds). Begin the massage by pouring the olive on your hands and warming it. Now apply the oil on around the entrance to the vagina and on the labia. Massage this area until the olive is absorbed.

Then insert your fingertip into your vagina and press it towards the sacrum and anus. After a few days, try to compress the vagina with two fingers. Depending on your options, massage with four fingers.

That way, when the time comes for delivery, Your crotch will be flexible and prone to pressure on the head. Remember that it is never too late to start a massage. It is best to start in the middle of pregnancy, however, even if you are in the third trimester of pregnancy, massage will not hurt, and it will definitely help. At a later stage of pregnancy, when your tummy may interfere with your bending and massaging, ask your partner for help.

Remember to do not massage the perineum during vaginal infection! This can facilitate its spread!

They are very helpful in preparing the perineum and muscles Kegel exercises. These are strengthening exercises that you can do anytime, anywhere! They rely on alternating tension and relaxation of the perineal and anal muscles. These exercises also help prevent and treat urinary incontinence and reproductive organ prolapse. Exercise even during and after the puerperium!

During delivery the probability of injury to the perineum is significantly reduced by vertical positions and childbirth in the water. Warm compresses and coffee compresses also help to make the crotch more elastic and relaxing.

Incision or not ?? - a controversial topic

The crotch incision has both its supporters and opponents. Proponents argue that prophylactic crotch incision (one that is not caused by a threat to the child's life) prevents many subsequent complications such as reproduction of the reproductive organ, urinary incontinence and cracks of the III and IV degree (these cracks cover the muscles and rectal mucosa in turn). A well-known argument for crotch incision is that a crotch incision is much easier to stock and heals better.

Scientific research that dealt with the subject of epizotomy excluded all these arguments.

Opponents of the epizotomy, however, point to hers negative effects such as soreness of the perineum, impaired healing, damage to the muscles of the perineum, which even after fusion are less tense. Many studies also say that an episiotomy does not prevent 3rd and 4th degree cracks at all, on the contrary, the incision facilitates further tearing of the wound. Another important argument against epizotomy is dyspareunia, or painful intercourse.

However, my thoughts are directed in a completely different direction. Why consider what impact on later complications have an episiotomy, if they can be solved in a completely different, simpler and more pleasant way? I believe that a vertical delivery would solve all problems. IN vertical position because very rarely there are any crotch fractures (so we don't have to be afraid of 3rd and 4th degree cracks). The problem of prolapse of the reproductive organ and urinary incontinence is, however closely related to too much pressure, which is forced by the supine position. In the vertical position, the forces of pressure are much smaller, due to the fact that the force of gravity helps us.

For these reasons, I hope that the procedure in Polish delivery wards will change slowly and that the actions of the Rodzić foundation humanly will bring results ...