Childbirth has been romanticized to its core. The majority of people in Albania, including doctors, are afraid to ruin this idealized image. A baby can be a great joy. It may be divine to give life to someone from your own body, but the natural process of childbirth is not beautiful, let alone romantic.

Maybe for this reason, mothers who choose natural childbirth are sometimes compared to “a goat that goes to the butcher.” They don’t know what will happen, they don’t know what awaits them. This secretive approach throws women into unknown situations, especially if this the first time they have given birth. Childbirth is like a labyrinth full of secrets, myths and anecdotes, preserved and untold. There is a reason that we say “thank god, you survived!” to mothers who have just delivered a baby. 

I have often heard about childbirth and the way it is treated by Albanian families, but I have never been more distressed than the moment I found out about episiotomies.

An episiotomy is an incision made in the perineum — the lower part of the vagina — during natural childbirth. Over time, the procedure has changed a little and now the incision is no longer made in the perineum, but in the lateral parts of the vagina. An episiotomy is usually performed to avoid natural perineal tearing and to make more room for the baby to come out or to speed up the birth.

A relative of mine came to visit who had given birth to her daughter just five days before. After breastfeeding, she came and sat with us. The women and girls of the family, sitting in a semicircle, began to talk about childbirth. When the young mother told us about the screams, some laughed, just as the midwives and nurses had done in the delivery room as she pushed a baby weighing over three kilograms out of her vagina. 

Then the conversation turned to episiotomy. While she was talking about the procedure, the older women’s facial expressions did not change. Who knows how many times they had experienced it? They were no longer impressed. Or, as I now think, in their minds motherhood is symbiotically related to sacrifice and suffering. At the end of the day, a small vaginal incision is a small price to pay to deliver a baby, I imagined them thinking.

Their facial expressions made me realize that they already knew, but why didn’t the new mother know? Why should episiotomies be kept a secret? Why should new mothers go through such an important process uninformed and unable to make decisions about their bodies? Why should the doctor make the decision the moment he holds the scissors in his hand?

Many women who have chosen to deliver their baby in Albanian state hospitals have had the same experience as my relative, although there is no data on the implementation of this procedure. The women I have spoken to were not informed in advance about the procedure. They were not given a choice as to whether they wanted their vaginas cut, or whether they wanted to go through the natural process of vaginal tearing, which may or may not happen depending on elasticity.

In all these years, talking to new mothers, I have realized the terrible reality associated with episiotomy. I’ve heard stories of women who have been cut five centimeters on each side of their vagina and perineum without knowing it, as if it was the most normal thing in the world. Without even knowing the name of the procedure being performed on their body.

We can’t know what doctors think or why they act the way they do. Perhaps they think that women are born with medical degrees and specialists in gynecology, or at least think we’re very good at doing our own research — there’s no other way to explain this lack of information.

Today, around the world, episiotomy is performed only when absolutely necessary for the mother and child and it requires the mother’s informed consent before it is performed. This is because in most cases the incision is more difficult to heal from than natural perineal tears. Despite this, episiotomy continues to be performed without the prior consent of the mother. The lack of proper information about this procedure continues to be an issue that is widely discussed and criticized.

It is both right and necessary for new mothers in Albania to be informed about episiotomy before seeing the doctor, scissors in hand, when the act is about to be performed. Women’s bodies should not be the evidence of a doctor’s failure to inform women about brutal and out of date practices. A woman’s body should not be a canvas for a”butcher with scissors to perform a final act before going out to drink a coffee with friends.

To respect women, your patients, means to inform them and present all the possibilities and risks that accompany a surgical procedure, to not interfere with her body, as if it was the most normal thing in the world, without at least giving her the opportunity to choose and decide for herself.

Feature Image: Gayatri Malhotra via CC license.