Is an Episiotomy Better Than Tearing Naturally?

When preparing to give birth, many expectant moms have heard about episiotomies and wonder if they will have one performed when they deliver their baby vaginally. A common question that they may ask their OB/GYN or midwife is if it is better to do an episiotomy or to let the opening of the vagina (also called the perineum) tear on its own.

An episiotomy is when an incision is made with scissors on the perineum at the time of delivery to help the baby deliver more easily. There are various types of episiotomies. We used to think that doing an episiotomy routinely on all women who delivered vaginally was helpful: it was thought this would prevent worse lacerations from happening on their own, help protect against urine or stool leakage (called incontinence) after giving birth, and prevent pelvic floor and sexual problems in the future. In fact, we used to think they were so useful that back in the 1970s, about 85 percent of women would have one performed when giving birth!

However, things have since changed. A study came out in the 1980s that showed that episiotomies weren’t all they were cracked up to be and that they didn’t really come with all the benefits we thought. Because of this, their usage was restricted, and as of 1994, only about 10 percent of women who deliver vaginally will have an episiotomy.

We now know that routinely using episiotomies on all women actually causes more problems than it prevents: these women have higher rates of third and fourth-degree vaginal lacerations and can have more bleeding after delivery and pain during healing. They should only be used when necessary, and the American College of Obstetricians and Gynecologists has adopted this as their official recommendation.

Keep in mind that an episiotomy still may be needed in certain circumstances. Reasons your doctor or midwife may recommend one include needing the baby to deliver more quickly (such as when his or her heart rate is dangerously low) or when more room to deliver is needed (such as in shoulder dystocia).

Therefore, in the majority of cases, it is definitely advisable to let any vaginal tearing happen on its own rather than performing a routine episiotomy. Remember, most first-time moms will have some tearing, and this is completely normal and usually causes no problems afterward. When meeting with your doctor or midwife, you may want to ask what their policy is on episiotomy usage and how often they perform them, so you can get an idea of where they stand.

Sources:

• Gabbe SG et al
• Obstetrics: Normal and Problem Pregnancies
• 5th ed.
  The American College of Obstetricians and Gynecologists
• Episiotomy: Procedure and repair techniques
• 2007.

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