Do I need to cut my vagina for a normal birth?

Giving birth is something that almost every woman has to go through. In ancient times, giving birth was a life-and-death moment for women. Due to the underdeveloped medical technology, many women would die during the childbirth process. With the development of medicine, women can now choose natural birth or caesarean section according to their own circumstances. Many women want to know whether they need to have a genital incision during a natural birth? Let’s find out below.

Natural birth is a method of childbirth. Natural birth is much better than caesarean section. At least the baby is intact and without defects after birth. This is the biggest temptation for women who love beauty. Caesarean section is a surgical procedure that can cause harm to the mother, both psychologically and physically.

For example, anesthesia accidents, intraoperative or postoperative bleeding, improper postpartum care, etc. Injury to the bladder, ureters, and intestines during surgery, and postoperative infections such as peritonitis and sepsis. The postpartum bleeding rate of cesarean section is high, the puerperal infection rate is 10 to 20 times that of vaginal delivery, and the maternal mortality rate is 5 times that of vaginal delivery. Natural delivery is a delivery method that is suitable for humans.

From the perspective of childbirth, we advocate natural childbirth because it is the safest for mother and baby. Specifically, during natural childbirth, the baby's lungs will be squeezed by the birth canal, and this squeezing is good for the baby. One of the reasons why some people choose cesarean section is to avoid squeezing the baby's brain, and say that the child will be smart after birth. In fact, this statement is completely wrong.

Some women need to undergo episiotomy during normal childbirth, and many people do not understand why they need to undergo episiotomy during natural childbirth. Experts say that there are indications for episiotomy, and not everyone needs to have it done. In fact, childbirth is a natural process, and it is internationally believed that the less medical intervention, the better. In recent years, obstetricians are also changing the idea that "episiotomy is a routine practice". During delivery, medical staff will try their best to protect the perineum of the mother. Some hospitals control the rate of episiotomy at 30% to 40%. The question is, what exactly is an episiotomy and why is it no longer recommended today?

Episiotomy is a surgery to ensure the smooth delivery of the fetus. Episiotomy is to make an oblique incision in the perineum. Episiotomy can prevent perineal tearing and protect the pelvic floor muscles of the mother. In addition to physiological reasons, the deeper reason for performing episiotomy for natural birth in China is the medical accident reverse prosecution system. If a woman giving birth naturally suffers perineal tear due to failure to perform an episiotomy, the hospital can assume all responsibility for not performing an episiotomy when the woman sues. Therefore, in order to avoid unexpected situations, public hospitals in mainland China have a tacit understanding to implement episiotomy for normal deliveries.

Episiotomy cuts the final exit of the fetus and artificially enlarges the exit to prevent irregular tearing. I have also seen mothers with rectal lacerations in the forum. Please imagine the suffering they have to endure during the recovery period after childbirth. The perineal opening varies in size and has different stretch elasticity. It's a bit like flexibility in yoga. Few people can do the splits on their first try, but most can achieve the goal with continued practice. What is the target? Generally speaking, it can be expanded to a diameter of 7 cm and there will be basically no tearing. Although the diameter of a full-term baby's head is about 9.5 cm, due to gaps in the skull, the actual squeezed diameter will be smaller than this value. Generally, the perineum that can perform normal sexual intercourse can maintain a stretchability of about 3 cm. Perineal massage is to allow the perineal muscles to continue to adapt to continuous stretching on this basis.

The area between the labia and anus is the perineum. They are usually only 2-3cm long, but can be stretched to about 10cm long during production. This is because hormones stretch the perineum to assist in the birth of the baby. Stretching the perineum is relatively difficult during a first delivery. An episiotomy is an oblique incision made in the perineum. Episiotomy not only includes lateral incision, but also medial incision (for the convenience of description, it is collectively referred to as episiotomy below). It can prevent perineal tears in parturients, protect the pelvic floor muscles, and surgical incisions are easier to repair and heal better.

The whole process of episiotomy

(I) Timing of incision

When the doctor sees the fetal head about to appear from the vaginal opening, he or she will immediately judge whether the baby is big and whether it will cause severe perineal tear, and then decide whether to perform an episiotomy. If the doctor judges that the delivery is going smoothly and the tear is not large even if the perineum is not cut, surgery can be avoided.

(II) Operation

The patient took the lithotomy position and used bilateral pudendal nerve block anesthesia. When the uterus contracted, the middle and index fingers of the left hand reached deep into the vagina to prop up the left vaginal wall. The perineum was cut open at a 45° angle to the left from the posterior perineum to the midline with episiotomy scissors. However, if the perineum is highly bulging, the cutting angle should be 60° to 70° to avoid damaging the rectum. The incision is generally 4 to 5 cm. After the incision is made, gauze should be applied to compress and stop the bleeding. If necessary, clamps and ligatures should be used to stop the bleeding.

3. Time

There is no need to spend time cutting slowly. Instead, it can be cut quickly and instantly with medical scissors. The length of the cut is only about 2-5cm, and it really feels like "a moment". When the labor pains are severe, some women may not even realize that the incision has been made.

4. Pain level

Since the incision is made at the peak of labor pain, the episiotomy is basically not felt. In addition, due to the effect of local anesthesia, there is no need to worry about pain during incision.

A big part of the reason the doctor decided to perform an episiotomy was to avoid perineal tearing in the mother. At this point, some practices of foreign mothers are worth learning. They usually start perineal massage and exercise every day at about 32 weeks of pregnancy to increase the flexibility and elasticity of muscle tissue.