Episiotomy... that's a word I had never heard before becoming pregnant. In fact, I may not have even come across it were it not for one fateful evening at my Bosnian language class.
I was attending a small language school in the neighbourhood and, although my teacher was quite dedicated, the few number of other students were not, and so for not the first time, I was alone with Sandra, our teacher. The conversation turned towards my pregnancy. I was starting to show, so I was talking more about it with people. At this point, I was planning to stay in the country for the birth. I had already researched a lot about natural birth and knew that I wanted this. My impression was that it would be possible in Bosnia, as one friend mentioned that the hospital where she gave birth didn't even have epidurals, so that seemed promising. Nevertheless, we had done little firsthand research into the situation, so I was quite pleased when Sandra started talking about her sister's birth experience. After a little while, she paused and said, "Now, I don't want to scare you, but I think there's something you should know. When my sister called us from the hospital to announce that she had had the baby, my grandmother asked to know whether my sister 'had been cut'. She said 'yes'. My grandmother said, 'oh yes, they always do that in Bosnia'."
As I walked home alone, along the cold, dark streets after class, I became filled with a kind of terror. I felt unsafe and violated as I imagined the Dr. cutting my vagina. When I got home, I googled "cut vagina birth" since I didn't understand what this cutting business was. I eventually figured out that what Sandra meant was an episiotomy - a practice whereby the skin between the vagina and the anus (the perineum) is cut as the baby's head is born. I saw that it was routinely practiced in the 1950's, as they believed it made for an easier delivery, as it widens the birth canal. It was also thought to prevent severe perineal damage during birth and heal better, since it easier to stitch up than a natural tear. Since then; however, it has not been practiced routinely in places like the UK and Australia because it was shown that it does not prevent severe tearing, and in fact, it could even lead to more severe tears. It does not heal faster, is more painful than a natural tear and may even cause bladder and bowel control problems in future. More enlightened care givers view episiotomy as excusable only during an instrumental delivery (forceps or ventouse), which I think should also be a rare occurrence, or when a more speedy delivery is needed because the baby is in distress. If Sandra was right, and they were still practicing episiotomy on all women, regardless of whether it was truly needed or not, this reflected very badly on the state of birth in Bosnia.
This was when I started to question whether I would be prepared to birth in a Bosnian hospital. Sandra's revelation had really scared me and so it set me off on a quest to know if it was true and to see what else was routinely done in Bosnian hospitals. I managed to talk to a few more women about their experiences and I was not very comforted. I finally was able to see a Dr. at Abdulah Nakas hospital and asked him a number of questions.
He was very surprised that I didn't want him to examine me or give me an ultra-sound. I guess it was very unusual for him to have patients who wanted to ask questions or go through a birth plan with him. I calmly went through my list, as he sat there bewildered and amused at the strange foreigner. For example, "Can I eat during labour?", "No, you might get nauseous and vomit and choke on your vomit", "Can my husband be there for the entire labour and birth?" "Not the labour, but part of the birth" (or the other way round, it wasn't clear), "Can someone else be with me who can translate in case it's needed?", "No. Everyone speaks English". He said that despite the fact that he already misunderstood several of my questions and sitting next to him was a non-English speaking nurse. "Can I have a water birth?", "Yes, but you can only stay in the water for two hours"... By this point, my opinion of the hospital wasn't too good. I felt that many of the hospital rules were outdated and unnecessarily restrictive. The fact that waterbirth was possible was definitely a plus, but combined with the rest, and the hospital's approach in general, I wasn't too hopeful about my chances of having the kind of experience I wanted. This was confirmed when I asked about episiotomy. "Yes, all first time mothers need an episiotomy." "Why?" "Because you don't want to risk tearing and it heals better than a tear." "What about if you have a water birth?" "Oh, we can still do it in water." "Really, you can do it in the water?" "Yes, of course. Trust me, I'm a surgeon."
Exactly, you're a surgeon, I thought. That's why you shouldn't be handling normal pregnancies and births! Your very useful skills should be reserved for when normal has turned pathological and the woman's body can no longer do what it normally can. But that's the thing, I don't think he, and many other obstetricians (obstetrics is a branch of surgery), do trust a woman's body to do what it was designed to do. That was essentially why I decided I needed to find another place to birth.
In the end, Lessan and I decided to return to Australia and have a homebirth there, attended by a midwife. A midwife is not a surgeon, she is someone who has been trained to assist normal births. It seems that, although there are midwives in Bosnia, they only practice in hospitals under the control of obstetricians.
And, as I side note, I now realize that it is difficult for hospitals to offer truly respectful care, as they are often affected by business models of functioning and so, even in places like the UK where midwives are basically in charge in hospitals, the situation is still not ideal.
Upon returning to Bosnia, a friend of ours, Maja, told me about her birth. She noted that the hospital did everything according to a "need for speed". She had a very painful (unwanted) episiotomy that left her in severe pain for weeks and then discomfort until six months post partum! Of course, everyone's experience is not as bad as hers, but still! It now seems to me that performing episiotomies, like many other interventions, is based on hospital convenience. The pushing phase, in a first time mother, can sometimes take three hours (and this is normal), but if an episiotomy is done, the baby can come out much faster. This is not only painful, traumatic and unnecessary for the mother, it could even be dangerous for the baby if they try to pull it out in the process. I don't know if they do this, just theorizing here, but if they did pull it out, it could force the baby to come out at angle that causes it to 'get stuck', i.e. shoulder dystocia, which is a major problem! Furthermore, Maja said she had asked not to have the episiotomy. They said, of course, we only do it when it's needed. They let her push for a while and then said that it was best to do the episiotomy to make more room. This strikes me as the hospital not having faith in a woman's ability to birth her baby, in what was, as far as I can tell, a normal birth situation.
During the pregnancy, I sometimes felt guilty about going to the effort we did to have a good birth experience, but now I don't. It was very worth it, as it was such an empowering experience that gave me so much confidence to proceed down the path of motherhood. And, by the way, I ended up having a natural tear during my birth. I didn't even notice it happening and I healed quickly, even with needing a couple of stitches.The sad thing is that I shouldn't have had to make such an effort to have a natural, undisturbed birth. Every woman should have access to respectful, empowering care for her birth. Interventions, like episiotomy, are wonderful if truly needed, but we should be wary of any 'routine' intervention in birth because birth is not a medical event needing to be managed, it is the body performing a function it was designed to do.
I was attending a small language school in the neighbourhood and, although my teacher was quite dedicated, the few number of other students were not, and so for not the first time, I was alone with Sandra, our teacher. The conversation turned towards my pregnancy. I was starting to show, so I was talking more about it with people. At this point, I was planning to stay in the country for the birth. I had already researched a lot about natural birth and knew that I wanted this. My impression was that it would be possible in Bosnia, as one friend mentioned that the hospital where she gave birth didn't even have epidurals, so that seemed promising. Nevertheless, we had done little firsthand research into the situation, so I was quite pleased when Sandra started talking about her sister's birth experience. After a little while, she paused and said, "Now, I don't want to scare you, but I think there's something you should know. When my sister called us from the hospital to announce that she had had the baby, my grandmother asked to know whether my sister 'had been cut'. She said 'yes'. My grandmother said, 'oh yes, they always do that in Bosnia'."
As I walked home alone, along the cold, dark streets after class, I became filled with a kind of terror. I felt unsafe and violated as I imagined the Dr. cutting my vagina. When I got home, I googled "cut vagina birth" since I didn't understand what this cutting business was. I eventually figured out that what Sandra meant was an episiotomy - a practice whereby the skin between the vagina and the anus (the perineum) is cut as the baby's head is born. I saw that it was routinely practiced in the 1950's, as they believed it made for an easier delivery, as it widens the birth canal. It was also thought to prevent severe perineal damage during birth and heal better, since it easier to stitch up than a natural tear. Since then; however, it has not been practiced routinely in places like the UK and Australia because it was shown that it does not prevent severe tearing, and in fact, it could even lead to more severe tears. It does not heal faster, is more painful than a natural tear and may even cause bladder and bowel control problems in future. More enlightened care givers view episiotomy as excusable only during an instrumental delivery (forceps or ventouse), which I think should also be a rare occurrence, or when a more speedy delivery is needed because the baby is in distress. If Sandra was right, and they were still practicing episiotomy on all women, regardless of whether it was truly needed or not, this reflected very badly on the state of birth in Bosnia.This was when I started to question whether I would be prepared to birth in a Bosnian hospital. Sandra's revelation had really scared me and so it set me off on a quest to know if it was true and to see what else was routinely done in Bosnian hospitals. I managed to talk to a few more women about their experiences and I was not very comforted. I finally was able to see a Dr. at Abdulah Nakas hospital and asked him a number of questions.
 |
| Episiotomy scissors |
Exactly, you're a surgeon, I thought. That's why you shouldn't be handling normal pregnancies and births! Your very useful skills should be reserved for when normal has turned pathological and the woman's body can no longer do what it normally can. But that's the thing, I don't think he, and many other obstetricians (obstetrics is a branch of surgery), do trust a woman's body to do what it was designed to do. That was essentially why I decided I needed to find another place to birth.
 |
| "Trust me, I'm a surgeon." At the end of the interview, he acted like he had done me a huge service by answering my questions. |
In the end, Lessan and I decided to return to Australia and have a homebirth there, attended by a midwife. A midwife is not a surgeon, she is someone who has been trained to assist normal births. It seems that, although there are midwives in Bosnia, they only practice in hospitals under the control of obstetricians.
And, as I side note, I now realize that it is difficult for hospitals to offer truly respectful care, as they are often affected by business models of functioning and so, even in places like the UK where midwives are basically in charge in hospitals, the situation is still not ideal.
Upon returning to Bosnia, a friend of ours, Maja, told me about her birth. She noted that the hospital did everything according to a "need for speed". She had a very painful (unwanted) episiotomy that left her in severe pain for weeks and then discomfort until six months post partum! Of course, everyone's experience is not as bad as hers, but still! It now seems to me that performing episiotomies, like many other interventions, is based on hospital convenience. The pushing phase, in a first time mother, can sometimes take three hours (and this is normal), but if an episiotomy is done, the baby can come out much faster. This is not only painful, traumatic and unnecessary for the mother, it could even be dangerous for the baby if they try to pull it out in the process. I don't know if they do this, just theorizing here, but if they did pull it out, it could force the baby to come out at angle that causes it to 'get stuck', i.e. shoulder dystocia, which is a major problem! Furthermore, Maja said she had asked not to have the episiotomy. They said, of course, we only do it when it's needed. They let her push for a while and then said that it was best to do the episiotomy to make more room. This strikes me as the hospital not having faith in a woman's ability to birth her baby, in what was, as far as I can tell, a normal birth situation.
During the pregnancy, I sometimes felt guilty about going to the effort we did to have a good birth experience, but now I don't. It was very worth it, as it was such an empowering experience that gave me so much confidence to proceed down the path of motherhood. And, by the way, I ended up having a natural tear during my birth. I didn't even notice it happening and I healed quickly, even with needing a couple of stitches.The sad thing is that I shouldn't have had to make such an effort to have a natural, undisturbed birth. Every woman should have access to respectful, empowering care for her birth. Interventions, like episiotomy, are wonderful if truly needed, but we should be wary of any 'routine' intervention in birth because birth is not a medical event needing to be managed, it is the body performing a function it was designed to do.
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