Paris (AFP)
"Before, it was the one who had not done that had to explain.Now, it's the opposite": Thierry Harvey, head of service at the maternity hospital of the Diaconesse Hospital in Paris, wants that each episiotomy is both justified and consented to by the woman giving birth.
This operation consists of a perineal incision, located between the vagina and the anus, to allow a faster exit of the newborn.
In recent years, it has become the symbol of "obstetric violence": this expression coined by feminists but disputed by some practitioners refers to medical procedures during childbirth that are not necessary or granted by the future mother.
The debate on these practices has led to awareness among women and highlighted the importance of consent during episiotomy, expressed by several health professionals at AFP.
"We talk a lot about it," said Victoria Astezan, president of the National Association of Midwifery Students (Anesf). "One wonders about the information of the patients and about the consent".
"There are some women who say before giving birth: + If you want to do an episiotomy, there is no problem, but I want to know about +, and that's normal," she says.
With mothers in full delivery, "the dialogue is not necessarily easy but we all agree that it is necessary", adds Claire Cardaillac, vice-president of the Association of Gynecologists-Obstetricians in Training ( Agof) and internal to Nantes University Hospital.
"No medical act or treatment can be practiced without the free and informed consent of the person and this consent may be withdrawn at any time", states the Kouchner law of 4 March 2002.
"During a normal delivery, the practice of an episiotomy is not recommended to reduce the risk of obstetric lesions of the anal sphincter," says the National Council of Gynecologists-Obstetricians of France (CNGOF).
Yet, according to a report of the High Council for Gender Equality (HCE) published in June 2018, "one woman in two on whom an episiotomy was performed deplores a lack or total lack of explanation on the ground" . An excess that the HCE has classified as "sexist acts during gynecological and obstetric follow-up".
- "Do everything to avoid it" -
The testimonies of abuse suffered during gynecological consultations have been on social networks and blogs since 2013. A recent documentary by Ovidie, "You will give birth in pain", gave the floor to women victims of violence at their birth, among which Marlène Schiappa, Secretary of State for Gender Equality.
So much so that the desire to reduce the practice of episiotomy has made a place in the classrooms. "Students are told: + You must do everything possible to avoid episiotomy +," assures Philippe Deruelle, a gynecologist-obstetrician at the University Hospital of Strasbourg and General Secretary of the CNGOF.
"I would like less than 10% of episiotomies in France", which corresponds to the recommendations of the World Health Organization (WHO), he says.
In 2016 in France, 20% of deliveries were still accompanied by an episiotomy, even if this proportion had considerably reduced compared to previous years (55% in 1998, 27% in 2010), according to the latest report. of Inserm.
This survey revealed disparities in French maternity hospitals. Since then, some have significantly reduced the practice: the hospital Diaconesses had 19% of episiotomies in 2016, a percentage that fell to 3% in 2018.
They followed in this way the path drawn by the maternity hospital CHU Besançon, pioneer in the reduction of episiotomies, with a rate reduced to less than 1% per year.
The practices evolve, considers Thierry Harvey. The head of department wanted to limit the too systematic use of this incision in his maternity and change the habits of his colleagues. "It was necessary to fight against this stupid sentence: + If you had made an episiotomy ... +", explains Dr. Harvey, entered the maternity of the Deaconesses in the 1980s.
"I do not remember my last episiotomy," says the obstetrician-gynecologist. In three years of study, Victoria Astezan saw "only one".
At present, the episiotomy is only decided at the last moment, "if the baby's head is too big, for example", explains Philippe Deruelle. Although it is now "infrequent", recourse to this practice remains inevitable in some cases.
© 2019 AFP