Episiotomy during childbirth: Is It Better Than Tearing?

All You Need To Know About Episiotomies


What is an episiotomy?

Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. An episiotomy is usually performed during the second stage of labor to quickly enlarge the opening for the baby to pass through.

It is a surgical cut in the muscle area between the vagina and the anus that allows more room for the baby’s shoulders to pass through during birth.

This is normally carried out when the medical team is worried about your safety during a complicated and prolonged birth or worried about the safety of your child.

Here are common reasons for an episiotomy:

  • Speed prolonged labor.
  • Assist with a vaginal delivery.
  • Breech presentation.
  • Delivery of a large baby.
  • Previous pelvic surgery.
  • Abnormal position of a baby’s head.
  • Delivery of twins.

What are the possible complications with an episiotomy?

Some possible complications of an episiotomy may include:
  • Bleeding.
  • Tearing into the rectal tissues and anal sphincter muscle which controls the passing of stool.
  • Swelling.
  • Infection.
  • Collection of blood in the perineal tissues.
  • Pain during sex.

Is it better to have an episiotomy or tear?

For years, an episiotomy was thought to help prevent more extensive vaginal tears during childbirth — and heal better than a natural tear. The procedure was also thought to help preserve the muscular and connective tissue support of the pelvic floor.

Routine episiotomies are no longer recommended. Still, the procedure is sometimes needed when your baby needs to be quickly delivered.
Current evidence doesn’t support the use of routine episiotomy. In most situations, if any tearing is going to occur, natural tearing has less risk and often heals better. Routine episiotomy increases the risk of severe tears, and long term perineal, vaginal, pelvic floor, and anal sphincter damage.

Why avoid an episiotomy?

There are diverse reasons why you would want to avoid an episiotomy, including:

  • This is a cut through the skin and muscles that makes it difficult, especially for a new mom to be as mobile as she would like when she takes care of her newborn baby.
  • The wound can be infected and lead to complications and increased pain and suffering.
  • It can tear further than the initial cut, even down to the anus, causing extra discomfort and pain.


Why tear naturally is better than to have an episiotomy?

Research has made known that women with spontaneous tears usually heal at the same time or less and often with fewer complications than those who have had an episiotomy.

Women with episiotomy tend to lose more blood at the time of delivery, suffer more during their recovery, and wait longer to have intercourse without being ashamed or having pain. As mentioned above, an episiotomy also radiates the risk of infection, and a recent study has shown that episiotomy for first vaginal delivery is associated with an increased risk of tearing at the next birth.

How long does it take to recover from an episiotomy?

Like any freshly repaired wound, the site of a laceration or episiotomy will take time to heal. Most episiotomies heal in 3 weeks. But it may take longer. This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace.

Recovering after an episiotomy: What to expect?

If you have had an episiotomy, you will have stitches in a susceptible area and need time to heal. Your stitches do not have to be removed – they dissolve automatically in weeks after delivery.

Have the wrapped ice pack on for 10 to 20 minutes at the most each time. Change sanitary pads often to keep the perineum dry. Rest as much as possible. You may want to lie with a pillow under your hips to elevate the area, or raise the foot of the bed.

How to prevent an episiotomy?

During pregnancy, you can practice the pelvic floor muscles to learn how to tighten and relax the pelvic floor muscles. During labor, you must be able to rest your pelvic floor muscles (while the natural reaction must contract them). By practicing this, it will be easier for you to relax your pelvic floor muscles during labor.

You can also start practicing a perineal massage from about 34 weeks of pregnancy. This may improve the elasticity of your perineum, reducing the risk of rupture and therefore reducing the need for an episiotomy.

You should also discuss your desire to prevent an episiotomy with your midwifery and hospital delivery team and indicate that you want to work with them to avoid an episiotomy or natural tears.

Many episiotomies are performed because the woman is exhausted at birth and can no longer continue giving birth. That is why it is essential to save energy during the stages of birth and to ensure that you get enough food, liquids, and rest. Talk about this with your midwife.

Here is a list of measures that can reduce the need for an episiotomy:

  • Good nutrition–healthy skin stretches more easily!
  • Kegels (exercise for your pelvic floor muscles)
  • A slowed second stage of labor where pushing is controlled
  • Warm compresses and support during delivery
  • Use of perineum massage techniques
  • Avoiding lying on your back while pushing
  • Having a natural birth without taking epidural.

In conclusion, there are many good reasons why you should avoid an episiotomy. Discuss your needs with your midwife and ask her to show you how to perform a perineal massage and how you can work with her during delivery to prevent an episiotomy.