If you had asked me last year when I first started my doula practice full time about episiotomies I would have told you “they’re a thing of the past,” or “they’re not really done anymore because we know natural stretching is better healing-wise for the pelvic floor.” But, if you ask me now, well you’ll get a whole new answer. One that’s pretty terrifying and, frankly, messed up. The most recent birth I was a doula for was incredible. I was honored to be a back up for a well-known doula in the city with an OB who I’d heard really good things about. When I got there Mom was handling contractions as if they were barely there. Truly amazing. When she was complete and ready to start pushing she was using her breath so effectively and efficiently, it was nothing I’d seen before - especially for a first time mom.
A little more than an hour into pushing her OB was in position to receive her baby. We were all cheering her on, coaching Mom to keep doing essentially what she was naturally compelled to do. And then something caught my eye. Something my eyes and heart cannot unsee. It was subtle. I almost didn’t even see it. Well, that part was intentional.
I looked down towards Mom’s leg because something shiny drew my attention. Her OB had placed a pair of surgical scissors underneath her legs, tucked under bottom as if was hiding them. Mom took a big breath to prepare for a contraction and pushing. I kept my eyes on those scissors wondering what the hell those were there for assuming they were just there “just in case,” but had to put my focus on supporting Mom.
Mom did her homework. She did her due-diligence. She had created a her Birth Preference Sheet and asked her OB to sign off on it so that it became a legal document between them. Consent had to be given to stray from this document. No episiotomy was something she felt strongly about so the thought of one did not even cross my mind.
My focus was on Mom as she drew in and beared down, connecting with a deep force coming from within her. And then, in less than a second, it happened. SNIP. CRY! In the middle of Mom pushing, she cut her. “I’m just going to make a little room,” OB said in less than a second. No consent. No chance to say no. No chance for me to say, “It looks like OB is getting ready to do an episiotomy, do you still feel strongly against it?” Mom had no opportunity to advocate for herself. But what’s really horrifying, what really makes my blood boil with disdain is the OB immediately hid them behind her back when she noticed I saw her do what she did and handed them to her surgical tech.
It gets worse.
Baby is delivered. She’s not “big” by any means. I mean Mom pushed for 2 hours, which for a first time mom is great when now ACOG recognizes 6 hours of pushing to be “normal” for a first time mom. So when OB is assessing her post-delivery of her placenta she says to Mom, “It looks really good down here, but you do have a 2nd degree tear that I’m going to take care of.”
What? Wait a second? She has a 2nd degree tear?
Did you mean to say,“I cut you unnecessarily without your consent, and am now going to sew up the damage I did to your pelvic floor which is probably going to cause problems down the road with incontinence, sex, muscular integrity, and your overall comfort and potential well-being.” ?
I waited for OB to say something about the episiotomy. I waited for the nurses to say something about the episiotomy. Radio silence. They backed up what the doctor said. They all, nurses and doctor, lied right to her. “You have a second degree tear.” Period.
With my doula clients I keep a timeline of what occurs during their labor. A little for myself so I can go back to see what was working and progress, but as a potential gift for moms. I type it up and make it beautiful so mom can process and hopefully cherish that day. I was sure to make mental note of when I saw the scissor, when she made the cut, and when she lied so I could write it down for myself and for Mom’s lead doula so she could inform her of what happened.
Did I say it gets worse? I meant to say boy does it get worse.
The doula that I was back up for asked in our city’s doula Facebook group if something similar had ever happened to them - the hiding, the no consent, and the lying. You would not believe how many doulas answered YES, to either their client or to them themselves. I could not believe what I was reading. Yes after yes after yes. And when discussion around it really started happening doulas were saying things like, “But I/she signed the general consent form so what could I/she do?”
This shit is happening all over our city? Don’t we know better? What is happening to these women who do not have a doula to support them? If this is happening in my city, is it happening in others? How the hell am I going to change this?!
A few facts about episiotomies: Episiotomies were first introduced in the United States by Dr. Joseph Delee, who (in his own words) viewed childbirth as a pathological process. By the 1950s, around 80% of first time mothers were receiving episiotomies “to help speed up labor”. The ironic thing is that episiotomies have actually been researched and found pointless. In 1983, the first paper to question the efficacy of episiotomies was published. Around 1985, the World Health Organization stated that the use of episiotomies was unjustified. Fast forward to 1995, a review in the Cochrane Library found that when done routinely, the procedure increases the trauma and complications of birth (Born In America).
Despite the evidence that episiotomies are, for the most part, worthless, it is thought that our national episiotomy rate is still at least ⅓ (Born in America).
BIRTHFIT is a state of readiness. BIRTHFIT is about expecting and postpartum moms taking charge of their bodies and their decisions. We support women in being self-advocates. We educate. We inform. We, and the women we support, are moving mountains in the birth world, righting wrongs world-wide. Here is one more wrong every woman should be aware of.
Informed consent is not because a doctor, nurse, midwife, etc. says so. It is being fully and completely aware of every single option available to you - all risks and all benefits - and informing you of your options before consenting to perform. You are not on the sidelines of your birth. You are not just a participant. Birth is not happening to you, it is happening through you. YOU are birthing your baby and it is only you who calls the shots. (Of course we know there are the outliers. We understand emergencies happen, but they are not the standard nor the norm).
The lead doula shared this information with Mom who was shocked to hear of this. She is processing and has decided to follow up with her OB/Gyn with questions. From there she said she and her partner will decide what, if any, actions will be taken. Regardless of the outcome and her decisions, please send love and healing vibes to Mom and any others who have been assaulted - knowingly or unknowingly - by a provider they have trusted.
Be informed. Be strong. Be the loudest self-advocate. This is you and your baby’s one birth.
Chelsea A. Craig MK, ATC, LAT