Episiotomy 101

Once upon a time, in a very dark age for birthing mothers, doctors thought that cutting vaginas was a splendid idea.

OUCH.

Luckily, we are in a much more enlightened age in regards to the episiotomy (the vaginal cut I referenced before), which was once thought to decrease tears, to heal better than natural tears, and to prevent organ prolapses.

Notice that I used the past-tense there. Was once thought. Not anymore.

There are two types of episiotomies: the mediolateral cut is angled down, away from the perineum. The midline cut is straight down into the perineum. The point of either type was to protect your perineum, but research shows that episiotomies often damage the tissues to a greater degree than a natural tear. The classic demonstration of this principle is done with a piece of paper. Tug on it hard, nothing happens. Make a small cut and then tug hard, and that paper tears right along the cut. In addition, a natural tear is easier for the body to heal.

Episiotomies lead to an increased possibility of infection postpartum, and may contribute to incontinence. Recovery may be painful, and sex may hurt for months afterwards.

Now, an episiotomy may be necessary if there is imminent danger to fetus requiring rapid delivery—especially if forceps or vacuum delivery is necessary—but in a normal delivery, the situation can probably be avoided. You can take precautions to lower your risk of needing an episiotomy such as:

• Proper pregnancy nutrition
• Plenty of kegels
• Third trimester perineal massage
• Perineal compresses during second stage of labor (AKA the pushing stage)
• Use of different birthing positions to facilitate easier descent for the baby

The American Congress of Obstetricians and Gynecologists (AGOC) now recommends the use of restricted episiotomies, rather than routine ones. Rates are dropping in America (although they are still high compared to many places in Europe), but some doctors refuse to give them up—regardless of what the evidence says. Most midwives tend to avoid episiotomies if at all possible, but it is still important to speak with your midwife to be certain of her policies.

Bottom line: Make sure you know what your care provider’s feelings on episiotomy are. If they are too episiotomy-happy, you might want to consider your options, whether that means an in-depth discussion of your desires with your current doctor or switching providers. After all, recovery is tough enough after you push a child out of your vagina. You might want to avoid getting cut if you can help it.