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.

One subject that can generate a lot of opinions is episiotomies. Do you need one? Do you even want one? First of all, let’s define the word: An episiotomy is a cut made by a physician in the lower opening of the mother’s vagina during delivery in the attempt to ease the passage of the baby through the vagina. Most episiotomy cuts are done straight down into the perineum, the area between the vagina and the anus.

OK, now that you know what it is, I bet you are wondering why doctors perform the episiotomy procedure. Traditionally, episiotomies were done by doctors when forcep delivery was a common practice. A cut enabled the doctor’s forceps to fit into the vagina in order to remove the baby.

According to a Centers for Disease Control’s 2001 study, forcep deliveries have decreased from a rate of 17.6 percent of all deliveries in 1980 to only four percent of all deliveries in the year 2000. Episiotomy rates, however, have not followed this same trend. Episiotomies have dropped to 32.7 percent of all deliveries versus 64 percent in 1988.

So, I bet you are wondering why doctors would still perform an episiotomy given that forcep deliveries are now done so infrequently.

Most of the reasons for the persistence of this procedure are based on incorrect information. Some doctors believe that an episiotomy will protect the pelvic floor against damage. A 2005 study published in the Journal of the American Medical Association, as well as other recent studies, proves this to be an incorrect assumption. These findings also show no evidence that a cut in the perineum “protects” the pelvic floor muscle.

Another frequently cited reason for doing an episiotomy is the belief that a natural tear repairs more slowly than a doctor-performed cut. This is untrue. A natural tear will actually heal much better than an episiotomy. Tearing is much safer than a cut; and while many people think that an episiotomy is easier to repair than a tear, this is not true, according to a 1987 study by J.M. Thorp and other doctors writing for the publication Obstet Gynecol.

Here’s another reason against cutting the skin to allow the baby’s head to pass during birth: Think of your skin as a cotton sheet. If you use scissors to create a physical cut, the fabric will rip and tear more easily. The last thing you want, therefore, is for a doctor’s cut to your vaginal area to continue to tear with the stress and strain created by the force of a baby being born, thus potentially injuring you or damaging your perineum. Use this analogy to think about how your skin tears, and you may decide that you don’t want or need an episiotomy. Always discuss this topic in depth with your caregiver.

As is always the case with many invasive procedures, episiotomies bring several risks to the mother. Infection, bleeding, hematoma, and post-partum pain are merely a few of the risks. Another interesting fact is that some studies have also shown that women who tear naturally during childbirth return sooner to sexual intercourse after giving birth than women who are “cut” by their physicians. (This finding was reported by P.G. Larsson and other doctors in a 1991 edition of Gynecol Obstet.)

Now that you know that routine episiotomies are not always necessary, there are some very rare cases where an episiotomy is necessary. Discuss these reasons with your caregiver so that you are prepared and educated in advance of your baby’s birth.

Do you want to know how to avoid an episiotomy? You can prevent the need for an episiotomy in several ways.

First and foremost is to become educated on the topic, including all the pros and cons of the procedure.

In addition, at the time of your delivery, ask your caregiver to instruct you on your pushing at the time of crowning. If a mom has instruction in controlled pushing, the vaginal skin will stretch naturally to accommodate the baby. This goes back to the thought that your body knows what to do.

You might also try the following suggestions: