An episiotomy is an incision made in the perineum, the tissue between the vaginal opening and the anus, during childbirth. Although an episiotomy was once a routine part of childbirth, that's no longer the case.
Your health care provider might recommend an episiotomy if:
- Your baby is in an abnormal position
- Your baby needs to be delivered quickly
So, the bottom line is that an episiotomy allows the baby to be born quickly if there is any distress or in a case of an emergency.
Routine episiotomy is not an evidence-based practice. Despite the evidence that the benefits and risks of episiotomy are not justified, some obstetricians persist in using it routinely for convenience, to finish the delivery more quickly.
Risks of Episiotomy
- Urinary incontinence
- Increased recovery time
- Can cause infection
- Increased discomfort when sex presumes
Episiotomies can leave long lasting, painful scars. A news release from ACOG states, “The best available data do not support the liberal or routine use of episiotomy. Nonetheless, there is a place for episiotomy for maternal or fetal indications such as avoiding severe maternal lacerations or facilitating or expediting difficult deliveries.”
How to avoid an episiotomy
- Hire a doula. In one study, the presence of a doula resulted in a 60 percent reduction in epidural requests, and a 40 percent reduction in forceps deliveries. Both procedures are major contributors to high episiotomy rates.
- Do prenatal massages to your perineum. Perineal massage, in which the perineum is massaged with or without oil can help stretch skin to allow for easier elasticity during birth
- Try different positions during childbirth, particularly positions where you are pushing with your legs far apart. Using gravity to your advantage can help not only the birth process, but also reduce the risk of tear.
Is tearing safe?
Research has shown that tears occurring naturally in an unmedicated mother happen when the perineum is at its maximum stretch, thereby creating a tear that is not jagged, but quite straight and minimal. Often this type of tear requires a maximum of three to five quick-healing stitches, if it needs any stitching at all.
In some cases, such as a rapid birth, an episiotomy may be needed to reduce a deep or long tear that can stretch into the anal sphincter.