I coached as my wife was delivering our third child. She was at the final phase of delivery where the last few pushes would result in the birth of our second daughter. As the crown of our daughter’s head protruded slightly from the very end of the birth canal, my wife’s obstetrician yelled, “Stop! Don’t push…”

He quickly positioned a hypodermic needle and injected anesthetic into a section of my wife’s perineal tissue - the skin between the vagina and the anus. Next he grabbed a scalpel and carefully addressed the freshly anesthetized area. The attending nurse and I instinctively wheeled our heads to the side so that our eyes could not see what happened next. “I never watch this part,” she told me, as the doctor quickly performed a simple procedure known as an episiotomy. Our daughter was born minutes later. As mother and daughter were meeting face-to-face for the very first time, the doctor was busy stitching the incision created during the episiotomy.

The idea behind performing an episiotomy is twofold. The first reason is concern for the baby. Passing through the vaginal canal is the most stressful time for a baby experiencing a traditional vaginal birth. Cutting the perineal tissue creates a wider opening so that the baby can slip through more easily. The second reason is, in theory, to prevent out-of-control tearing of the mother’s perineal tissue. The idea is that, by making an incision, the area affected by cutting or tearing is controlled to a certain extent by the attending physician. The problem is that not all mothers experience tearing, so the laceration can be unnecessary.

According to an article by Salynn Boyles published on WebMD (http://my.webmd.com/content/article/110/109783.htm), The Journal of the American Medical Association (Vol. 293 No. 17, May 4, 2005) reports that researchers screened nearly 1,000 medical resources published in the past 60 years looking for data measuring the effectiveness of the procedure. Data from twenty-six articles contained relevant content and were aggregated to form conclusions.

The article reported that there was “fair to good” evidence that the results of routine episiotomy were not advantageous over the results of those with restrictive use of episiotomy. In cases where episiotomy was performed routinely, the severity of the laceration, the degree of pain suffered, and the amount of medication needed to treat was no better than for cases where episiotomy was not routinely performed.

Though most of the individuals were not followed late into life, relevant studies have shown no benefit from episiotomy for the prevention of urinary incontinence or pelvic floor muscle relaxation. Studies have also shown that “impaired sexual function - pain with intercourse - was more common among women” who had the procedure. A report published in the British Medical Journal in January of 2000 reported that women who received episiotomies during delivery had a significantly higher incidence of anal incontinence - the inability to control bowel movements and gas - than their counterparts who did not receive the procedure.

At best episiotomy is something no one wants to observe; at worst it can cause pain, lengthen the time it would normally take for a couple to resume sexual relations, and cause anal incontinence. The ideal situation would be to not only avoid episiotomy, but also to avoid tearing.

Informed mothers are learning more about this subject and taking the time to speak with their obstetricians about it, well in advance of their scheduled birthing date. They are adopting a strategy that includes special exercises using a device called EPI

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Parents often ask me questions that start like this:

How do I get my child to ?

Be polite be considerate be generous share etc.

Regardless of what fills in that blank, part of my answer is always the same:

you don’t have to get your child to do anything!

Instead, you can show him or her by living your own life as an example, and making sure to notice and respond positively to any movement he or she demonstrates in the desired direction. I noticed how you looked right into Aunt Sally’s eyes as you answered her question. Most people really appreciate that!

In addition to modeling the desired behavior, I also recommend role-playing mock scenarios with puppets or dolls. Kids are very quick to pick up social norms when they don’t feel as though they are being lectured or judged. Puppets are fantastic for circumventing possible defensive responses.
Telling make-believe stories about an animal character learning the lesson you want your child to absorb is also very effective.

Finally, please make sure you are treating your child the way you want him or her to treat others. As the timeless poem reminds us children learn what they live!

Copyright Karen Alonge 2006

Karen Alonge is an intuitive life coach and parenting consultant with 20 years of experience helping families with all types of challenges. She offers consultations by phone, email, and IM. Clients often notice dramatic changes in their daily experience after only one session. Please visit http://www.karenalonge.com for more information.

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Want to be a better parent? Knowing what your current parenting style is will help you identify your needed areas for improvement. Promoting the self-discipline and self-esteem of the children in your family often requires an emotional juggling act by you as a parent. It is not easy to be firm and demanding with a child one minute, then warm and affectionate the next. This is an ongoing education process both for the parent and for the child. In addition, many adults naturally have personalities or temperaments that predispose them toward one parenting style or another.

Authoritarian Parenting

Parents who tend to overemphasize the discipline side of the equation are referred to as authoritarian. Authoritarian parents are demanding in the worst sense of the word. They are intimidators, requiring obedience and respect above all else. They become overly angry and forceful when they don’t get that obedience and respect. Their love and acceptance appear totally conditional to the child. They do not teach or listen to their kids or explain the reason for their expectations, which are frequently unrealistic. They often see their children’s individuality and independence as irrelevant or threatening.

Research has shown that authoritarian parents tend to produce children who are more withdrawn, anxious, mistrustful and discontented. These children are often overlooked by their peers. Their self-esteem is often poor.

Permissive Parenting

Parents who overemphasize the self-esteem side of the equation are referred to as permissive. They may be warm and supportive, but they are not good disciplinarians - even in the privacy of their own home. They make only weak demands for good behavior and they tend to avoid or ignore obnoxious behavior. They seem to believe that children should grow up without any anger, tears or frustrations. They reinforce demanding and inconsiderate behavior from their children and often find it easier to just give in to their child’s demands. Their love and acceptance are “unconditional” in the worst sense of the word, for they set few rules or limits on what their children do.

Research has shown that permissive parents tend to produce children who are more immature, demanding and dependent. These children are often rejected by their peers. Their self-esteem is often unrealistic and hard to interpret, for they often blame others for their problems and misfortunes.

The Authoritative Parenting Model

Parents who are able to provide for both the discipline and self-esteem needs of their youngsters are referred to as authoritative. They clearly communicate high but not unrealistic demands for their children’s behavior. They expect good things from their kids and reinforce those things when they occur. They also tend to give more positive encouragement at the right places. When kids act up, on the other hand, authoritative parents respond with firm limits, but without fits of temper. They are warm, reasonable and sensitive to a child’s needs. They are supportive of a child’s individuality and encourage growing independence.

Authoritative parents tend to produce competent children. These kids are more self-reliant, self-controlled, content and happy. They are usually accepted and well-liked by their peers and perform better in school. Their self-esteem is good and they report having a happier childhood experience overall.

Where Do You Need Work as a Parent?

Logic and research, then, support the idea that children need both firm discipline and emotional support to grow up psychologically healthy. After reading the descriptions of the parenting styles above, if you found that you leaned too much toward the demanding, authoritarian style, then you need to work on the warm, supportive side of parenting. You need to have more fun with your kids, listen better and dole out more praise. If on the other hand, you leaned too much toward the permissive style, you need to work on establishing clear rules, setting limits, and confronting obnoxious behavior. Need to modify your parenting style? Start today!

Dr. Thomas Phelan is the best selling author of the 1-2-3 Magic parenting program, available in books, videos and DVD at http://www.ParentMagic.com. A registered clinical psychologist and an internationally renowned expert on child discipline and Attention Deficit Disorder, Dr. Phelan’s books also include 1-2-3 Magic for Teachers, Surviving Your Adolescents and All About Attention Deficit Disorder.

Copyright © 2006 ParentMagic, Inc.

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