These are wise words for today’s practices around sup porting the perineum during birth but were written over 300 years ago. Dahlen and colleagues’ paper makes for fascinating reading about the pathologisation of the peri neum over the last few hundred years. It also hints at a related issue re gard ing agency over the body, which is espe cially rel ev ant for this chapter on the perineum and birth. A hands off approach to the perineum challenges the notion that a woman’s body has become pub lic prop erty for the childbirth professionals. The sense of their body becoming pub lic is reflected in the comments made by some women that labour requires you to put aside inhi bitions about exposing your body and retaining ‘dignity’, often said in a light hearted way. Yet as Dahlen’s paper reminds us, the privacy of the body was fiercely guarded in the past and still is in home birth where no strangers are allowed. Why should it be any different in institutional birth? Does anyone have a right to touch the private places of the body? If there is a need to touch, then who touches and how are im port ant subsidiary questions. Two papers in the past decade alert us to the as sump tions that institu tional birth have made about the first two questions (the need to touch and the professionals’ prerogative to do so) so that stories of women’s pain are about the ‘how’ of touch. Sanders et al.’s (2002) questionnaire on perineal repair found that 16 per cent used terms such as ‘distressing’, ‘horrible’ or ‘excruciating’ to de scribe the pain of repair and Salmon’s (1999) earl ier inter views of women found a sim ilar lack of adequate analgesia. In addition, women complained of the insensitivity of male doctors who made little attempt to estab lish rapport prior to suturing, illustrating the concerns over ‘who’ touches bodies in birth. The research that has been carried out around care of the perineum reflects the childbirth professionals’ pri or ities. When the HOOP trial (McCandlish et al. 1998) was published, answering the question that had vexed midwives for years (whether hands on techniques at the time of birth resulted in better perineum outcomes than a hands off technique), a surprising omission was any attempt to seek maternal ex peri ences of the two techniques. Surely women would have a view of the dif fer ence between the passive ‘being deliv ered of a baby’ or the more active birthing ‘under their own steam’. The amount of research on the choice of suture mater ial and method of repair represents another professionally led focus that may not have had the
same pri or ity for women. When was the last time a woman thanked you for stitching with Vicryl Rapide or for using subcuticular method instead of some other suture or different repair technique? One of childbirth’s darkest chapters may well have never happened if women had been involved with its con sidera tion from the beginning: episiotomy.