Episiotomies – The Kindest Cut or the Unkindest?

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Episiotomies

As with many things about labor and delivery, there is a lot of conflicting information out there about episiotomies. Some people say they are never needed while other say that they can prevent more serious injury.

What Is an Episiotomy?

An episiotomy is a cut made to opening of the vagina and the perineum (the area between the anus and the vagina) in order to open the birth canal more rapidly to allow the baby to pass through. This cut is performed by the doctor or midwife usually with blunt tipped scissors. The perineum can tear during childbirth if the baby is large and delivery is quick; the theory was that a straight surgical cut is easier to repair than a tear.

That was the theory. At one time, very few women who gave birth vaginally did not have an episiotomy done. They were done on virtually every woman and if the woman suffered problems afterward, the prevailing attitude was that it saved the health of the baby. But the rate at which episiotomies are done has been dropping in recent years as studies have shown that they can be avoided safely. Last year, a study reported that an estimated 25% of vaginal deliveries in the United States between 2006 and 2012 involved an episiotomy.This is down from an estimated 60% in the 1980s. The American Congress of Obstetricians and Gynecologists now recommends that episiotomies not be done routinely.

The reasons for the drop are many. Many women complained of pain and loss of function after an episiotomy. They had scar tissue that interfered with sex, or loss of anal continence, or continued discomfort. Research found that an episiotomy does not prevent all tears of the perineum and that the surgical cut could be more extensive than a tear would be. Studies found that massaging the perineum before and during delivery helped it stretch in time.2

If you want to avoid an episiotomy, talk to your healthcare provider during your prenatal visits. Ask your doctor or midwife about their thoughts on episiotomies and how often they use them. Tell him or her clearly that you want to avoid an episiotomy if possible.Have a birth plan in place that states that you do not want an episiotomy unless it is absolutely necessary.

There are ways to minimize the need for an episiotomy. Many healthcare providers now recommend stretching exercises in the last weeks of your pregnancy along with massaging the perineum to help the area stretch during delivery. Your doctor or midwife will give you instructions on how to do this properly.3

Your doctor or midwife can also use warm compresses and perineal massages with oil during the early stages of your delivery to help the perineum stretch. You will also be asked to control your pushing at times to allow for this stretching to occur.

When an Episiotomy Is Still Needed

Even with the best plans in place and all the precautions in the world, you still may need to have an episiotomy done. An episiotomy may be necessary if you are having a very large baby, if your baby is in a poor position, if your baby is in distress and must be delivered quickly, or if your pushing cannot be controlled and the baby is coming too quickly. Like many other things about labor and delivery, your plans have to take several eventualities into account.

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References:

  1. Friedman AM, Ananath CV, Prendergast E, et al: Variation in and factors associated with the use of episiotomy. JAMA. 2015;313(2):197-199. doi:10.1001/jama.2014.14774.
  2. Mayo Clinic Staff. Episiotomy: When it’s needed, when it’s not.
  3. American Pregnancy Association. Episiotomy.
Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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