What is an episiotomy?
An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening.
Obstetricians used to do episiotomies routinely to speed delivery and to prevent the vagina from tearing, particularly during a first vaginal delivery, in the belief that the “clean” incision of an episiotomy would heal more easily than a spontaneous tear. Many experts also believed that an episiotomy might help prevent later complications, such as incontinence.
But many studies over the past 20 years have shown that this is not the case. In fact, there is no good evidence that episiotomy offers your vaginal tissue and pelvic floor muscles any real protection, and the procedure may actually cause problems. For this reason, the American Congress of Obstetricians and Gynecologists as well as a host of other experts now agree that the procedure shouldn’t be done routinely.
The incidence of episiotomies has been on the decline, from nearly 2 out of 3 vaginal births in 1979 to less than 1 in 5 in 2004. (The number of episiotomies done for forceps or vacuum-assisted deliveries is significantly higher, though these have also showed a decline over time.) There are some experts, though, who think the number could be lower still.
Why is it better to tear naturally than to have an episiotomy?
Research has shown that women with a spontaneous tear generally recover in the same or less time and often with fewer complications than those who had an episiotomy.
Women who have an episiotomy tend to lose more blood at the time of delivery, have more pain during recovery, and have to wait longer before they have sex without discomfort. An episiotomy also increases the risk of infection, and a recent study showed that getting an episiotomy for a first vaginal birth is linked to an increased risk of tearing in the next birth.
What’s more, women who get an episiotomy may be likely to end up with a serious tear through the anal sphincter or even all the way through the rectum (known as a third- or fourth-degree laceration, respectively) than those who deliver without being cut.
These serious tears result in more perineal pain after the birth, require a significantly longer recovery period, and are more likely to interfere with the strength of the pelvic floor muscles. Tears that disrupt the anal sphincter make it more likely that the mom will have anal incontinence – trouble controlling bowel movements or gas.
Why might I need an episiotomy?
There are a few situations in which an episiotomy might be helpful.
If your baby is very large and your practitioner needs a little extra room to manipulate him during delivery or to apply forceps, she may opt to do an episiotomy. And if your baby needs to be born as quickly as possible – because his heart rate shows he isn’t handling the last minutes of labor well – your practitioner may decide that an episiotomy will help expedite the delivery. In these scenarios, an episiotomy may be essential to ensure your baby is delivered safely.
How can I make sure I won’t have an unnecessary episiotomy?
Talk to your practitioner early on about the procedure.
Ask how often and under what conditions he would perform an episiotomy, and how he might help you avoid tearing. (Also ask about others in the practice, in case you end up with someone else at your delivery.) Studies show that, as a group, midwives tend to do far fewer episiotomies than obstetricians.
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