The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

How to Cope with Fears about Episiotomy or Tearing

First, find a caregiver with a low suture rate. Asking about the episiotomy rate tells you about their attitude towards women and birth, and asking about their suture rate tells you about their skills in preventing tears.

I'm a homebirth midwife, and preventing tears is one of my personal passions. I put a lot of energy into it, and I learn as much as possible about it. Of my first 10 births, only two women needed suturing. One of those had an episiotomy because the baby was starting to look compromised and needed to be born quickly, and the other was victimized by an overly aggressive supervising midwife who had a phobia about shoulder dystocia and actually reached her hand inside, alongside the shoulder. Yes, she tore.

Other than those, one had a very slight tear (about 1/4 inch at the "v" of the perineum), and others had only minor internal lacerations, none of which required suturing.

Of my last 16 births, my suture rate is 0%. The largest of these babies was 9 lbs, 3 oz. with a 15-inch head that wasn't molding well.

I have seen 10-pound babies born without tears and have heard stories about 11- and 12-pound babies born without tears. My experience leads me to believe that almost all tears can be prevented if the caregiver has the interest and skills.

It bothers me that many other caregivers are cavalier about this. Yes, tears are "better" than episiotomies, but not tearing at all is best.

We, the "patients", the clients, the consumers, must insist upon better care. Ask every caregiver what their suture rate is. If it's over 20%, ask why it's so high and what they're doing to bring it down. If they say it's impossible or they don't know how, ask if they'll allow you to bring a midwife as a "labor coach" to show them how to prevent tears.

Women deserve to give birth without being cut or torn. Having your perineum cut or lacerated is not an acceptable right of passage. I agree with Jessica Mitford that episiotomy (or a cavalier attitude about tearing) is the American form of female genital mutilation.

So, do what you can to find a caregiver who knows how to protect *your* perineum.

Once you've addressed the practical issues of preventing tears, it makes sense to address your fears.

For subconscious fears, hypnotherapy can work wonders - it doesn't have to delve into the causes of the fear, it just overrides those fears to get you through the situation in good shape.

For conscious fears, you might want to take a look at Henci Goer's chapter on episiotomy. It's online, with other parts of her book, *Obstetric Myths Versus Research Realities*.