The World Health Organisation guidance for avoidance of episiotomy in non-critical situations is now 30 years old and episiotomy is still a common procedure. Tearing of the perineum is much more likely in cases where women give birth on their backs; this is also a common practise. The result of these truths is that many women will enter into their postnatal phase with trauma to the perineum. They will be caring for a baby whilst healing a part of the body which is highly sensitive to infection and pain.
As doulas travelling alongside women on their perinatal journey, we are uniquely placed to understand the long term impact of episiotomy and perineum trauma. As a result many of us are passionate about creating conditions in which women can birth their babies without tearing or undergoing cutting. Much of our time is focused on educating about optimal foetal positioning, upright positions for birth, the impact of continual monitoring on maternal mobility and the importance of intuitive and active methods of birthing. Sometimes when doulas aren’t present or when despite our best efforts it becomes necessary, tearing and cutting are unavoidable.
For centuries midwives and herbalists have been providing essential care in the treatment and prevention of infection and healing. In many cases, infection can be prevented by gentle care, prudent application of herbs and homeopathic remedies, use of poultices, compresses, baths and later into the post partum, steams. These can also play a role in restoring tone, strength and integrity to the tissues of the vagina.
Current NHS guidelines for caring for the perineum is for women to use ‘ water in the area and observe good personal hygiene’. This is woefully inadequate. In my clinical experience of the post partum phase, the incidence of perineal infection in women following just this protocol is high. This often leads to the use of antibiotics and in some cases, two or three different types may be employed before the infection is adequately addressed. There are further implications of this for mother and child. Damage to the microbiome of the baby can result in compromised immunity and digestive complications and impact on mother’s vaginal flora can lead to a long journey with Candida infections. In tissues whose healing is slower and where inflammation becomes more chronic, the incidence of pelvic disorders like prolapse and urinary incontinence is higher.
With adequate care the mother/child dyad can avoid the distress and discomfort of perineal infection, disruption to the immunity, digestive development and bonding for their babies. Natural approaches are long-overdue a recognition in their role in addressing perineal recovery. They are effective, microbe inhibiting and soothing and can make the transition into motherhood infinitely easier than water alone.
Useful Links
https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/care-during-labour-2nd-stage/who-recommendation-episiotomy-policy-0
https://www.rcm.org.uk/sites/default/files/Positions%20for%20Labour%20and%20Birth.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134148/
https://www.ncbi.nlm.nih.gov/pubmed/16128969