Episiotomy vs. Tearing
If you are planning on a vaginal birth,whether or not to have an episiotomy is an important decision to consider. While all women know that child birth is painful, the thought of having her vaginal area cut or torn is very frightening. It is best to know all the options available before labor begins, so that your birth plan expresses your specific wishes.
Episiotomies
Are episiotomies necessary? Many women today say no. Episiotomies used to be done routinely during a vaginal child birth by the doctor or midwife as a way to help the woman avoid getting a tear.
There are two main types of episiotomies – the midline and the mediolateral. The midline is when the doctor makes the incision straight down towards the anus, and the mediolateral is an incision made diagonally to help avoid a later tear into the anal area.
Episiotomies are said to have both positive and negative aspects
The benefits can include:
- Faster birth
- Prevention of tearing
- Protection against incontinence
- Protection against pelvic floor relaxation
- Faster rate of healing than tears
The negative aspects can include:
- Infection
- Increased pain
- An increase in 3rd and 4th degree vaginal lacerations (euphemistically called extensions)
- Longer healing times
- Increased discomfort when intercourse is resumed
Many midwives believe that there are better ways to avoid a tear than getting an episiotomy. These might include:
- Good nutrition (healthy skin stretches more easily)
- Kegels (exercise for your pelvic floor muscles)
- Prenatal discussion with your care provider about episiotomy
- Prenatal perineal massage
- A slowed second stage (controlled pushing)
- Warm compresses, perineal massage and support during delivery
Tearing
Many organizations that do not consider episiotomies as necessary believe that it is better for a woman to tear, but is it really? Some make the argument that not every woman will tear, and that those that do may only tear a tiny bit, resulting in only one or two stitches, vs. the 10, 20 or even more needed with an episiotomy. Not every woman will tear during delivery, and so some women may have episiotomies unnecessarily.
There is a negative side to allowing your body to tear naturally as well. Both episiotomies and tears are considered by degrees. The most common is the second degree tear or cut, which extends halfway back to the woman’s anus. The least common, but most painful, is the fourth
Both options today are acceptable in the medical field, and episiotomies are actually done less routinely than they used to be on pregnant women. It is best for a woman to research both options before she goes into labor so that she can choose which one she prefers while writing out her birth plan, and talking to the doctor at delivery.
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