Naming routine episiotomy for what it is: female genital mutilation. Conceptual contributions from childbirth experiences in Chile
Abstract
During the 20th century, episiotomy expanded as a practice in obstetrics. At present, after more than three decades of solid scientific evidence that recommends not practicing it routinely, it continues to be performed in alarmingly high numbers. This article analyzes the cultural meaning of episiotomy as a rite within technocratic childbirth, based on childbirth testimonies given by women in the First Survey on Childbirth in Chile, carried out by the Chilean Obstetric Violence Observatory in 2017. These testimonies show that episiotomy is, in most cases, practiced routinely, without consent, and that it has serious consequences in the physical and mental health and in the sexual life of women. Thus, it can be considered as a western form of female genital mutilation. We conclude by stating that it is urgent to attend to this practice and name it for what it is: a form of genital mutilation with serious consequences in the lives of women, which must be made visible.
Downloads
Metrics
References
Abdalla, S. M., & Galea, S. (2019). Is female genital mutilation/cutting associated with adverse mental health consequences? A systematic review of the evidence. BMJ Global Health, 4, e001553. http://dx.doi.org/10.1136/bmjgh-2019-001553
Belizán, J. M., Miller, S., & Salaria, N. (2016). We need to stop female genital mutilation! Reprod Health, 13, 43. https://doi.org/10.1186/s12978-016-0131-2
Berg, R. C., Denison, E., & Fretheim, A. (2010). Psychological, Social and Sexual Consequences of Female Genital Mutilation/Cutting: A Systematic Review of Quantitative Studies. Norwegian Knowledge Centre for the Health Services (NOKC).
Binfa, L., Pantoja, L., Ortiz, J., Gurovich, M., Cavada, G., & Foster, J. (2016). Assessment of the implementation of the model of integrated and humanised midwifery health services in Chile. Midwifery, 35, 53-61. https://doi.org/10.1016/j.midw.2016.01.018
Chibber, R., El-Saleh, E., & El Harmi, J. (2011). Female circumcision: Obstetrical and psychological sequelae continues unabated in the 21st century. Journal of Maternal-Foetal & Neonatal Medicine, 24(6), 833–836. https://doi.org/10.3109/14767058.2010.531318
Cohen Shabot, S. (2016). Making loud bodies ‘‘feminine’’: A feminist-phenomenological analysis of obstetric violence. Human Studies, 39, 231-47. https://doi.org/10.1007/s10746-015-9369-x
Davis-Floyd, R. (2018). Ways of Knowing about Birth: Mothers, Midwives, Medicine, and Birth Activism. Waveland Press.
Davis-Floyd, R. (2003). Birth as an American rite of passage. University of California Press.
DeLee, J. B. (1920). The prophylactic forceps operation. Am J Obstet Gynecol, 1, 34– 44.
Diniz, S. G., & Chacham, A. S. (2004). “The cut above” and “the cut below”: The abuse of caesareans and episiotomy in São Paulo, Brazil. Reproductive Health Matters, 12(23), 100-110. https://doi.org/10.1016/S0968-8080(04)23112-3
Diniz, S. G., & d’Oliveira, A. F. (1998). Gender violence and reproductive health. International Journal of Gynecology & Obstetrics, 63(1), S33-S42. https://doi.org/10.1016/S0020-7292(98)00182-9
Dogan, B., Gün, I., Ozdamar, O., Yilmaz, A., & Muhçu, M. (2017). Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain. J Matern Fetal Neonatal Med, 30(4), 457-460. https://doi.org/10.1080/14767058.2016.1174998
Ejegard, H., Ryding, E. L., & Sjögren, B. (2008). Sexuality after Delivery with Episiotomy: A Long-Term Follow-Up. Gynecol Obstet Invest, 66, 1-7. https://doi.org/10.1159/000113464
Gabbe, S. G. (2002). The Prophylactic Forceps Operation (comment). American Journal of Obstetrics and Gynecology, 187(1), 254-255. https://doi.org/10.1067/mob.2002.123205
Girard, M. (1999). Episiotomy: A form of genital mutilation (correspondence). Lancet 354(9178), 595-596. https://doi.org/10.1016/S0140-6736(05)77947-2
Gün, İ., Doğan, B., & Özdamar, Ö. (2016). Long- and short-term complications of episiotomy. Turk J Obstet Gynecol, 13(3), 144-148. https://doi.org/10.4274/tjod.00087
He, S., Jiang, H., Qian, X. & Garner, P. (2020). Women’s experience of episiotomy: a qualitative study from China. BMJ Open 10, e033354. https://doi.org/10.1136/bmjopen-2019-033354
Jiang, H., Qian, X., Carroli, G., & Garner, P. (2017). Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD000081. https://doi.org/10.1002/14651858.CD000081.pub3
Kitzinger, S. (1981). Episiotomy: Physical and emotional aspects. National Childbirth Trust.
Kitzinger, S. (2012). Birth & Sex. The power and the passion. Pinter & Martin.
Laqueur, T. (1990). Making Sex: Body and Gender from the Greeks to Freud. Harvard University Press.
Lagarde, M. (1994). Democracia genérica. REPEM México y Mujeres para el Diálogo.
Machado, C. M. (2018). Su cuerpo y otras fiestas (Her Body and Other Parties, traducción al español de Laura Salas). Anagrama.
MINSAL, Ministerio de Salud, Gobierno de Chile. (2008). Manual de atención personalizada en el proceso reproductivo. Departamento Ciclo Vital División Prevención y Control de Enfermedades Subsecretaría de Salud Pública, MINSAL.
Mulongo, P., McAndrew, S., & Hollins Martin, C. (2014). Crossing borders: Discussing the evidence relating to the mental health needs of women exposed to female genital mutilation. Int J Ment Health Nurs, 23, 296–305. https://doi.org/10.1111/inm.12060
Murray, S. (2000). Relation between private health insurance and high rates of caesarean section in Chile: Qualitative and quantitative study. BMJ, 321, 1501-1505. https://doi.org/10.1136/bmj.321.7275.1501
Murray, S., & Elston, M. A. (2005). The promotion of private health insurance and its implications for the social organisation of healthcare: A case study of private sector obstetric practice in Chile. Sociology of Health & Illness, 27(6), 701-721. https://doi.org/10.1111/j.1467-9566.2005.00470.x
O’Connell, H. E., Sanjeevan, K. V., & Hutson, J. M. (2005). Anatomy of the clitoris. J Urol., 174(4 Pt 1), 1189-1195. https://doi.org/10.1097/01.ju.0000173639.38898.cd
Organización Mundial de la Salud [OMS]. (2018). Recomendaciones de la OMS Para los cuidados durante el parto, para una experiencia de parto positiva. Resumen de orientación (español). https://acortar.link/S3m4WT
Organización Mundial de la Salud. (2020, 3 de febrero). Mutilación genital femenina. https://acortar.link/42xVnt
Observatorio de Violencia Obstétrica Chile [OVO Chile]. (2018). Resultados primera encuesta sobre el nacimiento en Chile. OVO Chile.
Palma, M. (1992). La mujer es puro cuento. Feminidad aborigen y mestiza. Tercer Mundo.
Pietras, J., & Taiwo, B. F. (2012). Episiotomy in modern obstetrics-necessity versus malpractice. Adv Clin Exp Med, 21(4), 545-550.
Reisel, D., & Creighton, S. M. (2015). Long term health consequences of Female Genital Mutilation (FGM). Maturitas, 80(1), 48-51. https://doi.org/10.1016/j.maturitas.2014.10.009
Rhodes, L. A. (1996). Studying biomedicine as a cultural system. En C. Sargent y T. Johnson (Eds.), Medical anthropology: Contemporary theory and practice (pp. 165-180). Praeger.
Simonović, D. (2019). Informe de la Relatora Especial de Naciones Unidas sobre la violencia contra la mujer, sus causas y consecuencias. Enfoque basado en los derechos humanos del maltrato y la violencia contra la mujer en los servicios de salud reproductiva, con especial hincapié en la atención del parto y la violencia obstétrica. (Doc. N° A/74/137). United Nations Digital Library. https://digitallibrary.un.org/record/3823698?ln=en
Song, M., Ishii, H., Toda, M., Tomimatsu, T., Katsuyama, H., Nakamura, T., Nakai, Y., & Shimoya, K. (2014). Association between sexual health and delivery mode. Sex Med, 2, 153-158.
Wagner, M. (1999). Episiotomy: A form of genital mutilation (correspondence). Lancet, 353(9168), 1977-1978. https://doi.org/10.1016/S0140-6736(05)77197-X
Weeks, F., Pantoja, L., Ortiz, J., Foster, J., Cavada, G., & Binfa, L. (2017). Labor and Birth Care Satisfaction Associated with Medical Interventions and Accompaniment During Labor Among Chilean Women. J Midwifery Women´s Health, 62(2), 196-203. https://doi.org/10.1111/jmwh.12499
Zachary, A. (2018). The Anatomy of the Clitoris: Reflections on the Theory of Female Sexuality. Routledge.
Copyright (c) 2022 Michelle Sadler
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
