What is an Episiotomy?

An episiotomy is a surgical incision made at the base of the vagina toward the rectum at or immediately prior to the newborn delivery. Episiotomies range from less than an inch in length to approximately two inches, depending on the circumstances and the type of episiotomy being performed.

Are Episiotomies Common?

Episiotomies have been routinely performed by obstetricians in the United States since at least the 1930’s.  In fact, episiotomies have historically been one of the most common surgical procedures performed in the United States. It is estimated that as many as 30-35% of births in the United States are accompanied by episiotomies. It should be noted that this is down considerably in the past several decades (the percentage was thought to be over 60% in the 1980’s). According to the Census Bureau, in the United States the number of live births exceeds 4.3 million live births per year. This suggests that well over 1.5 million women undergo episiotomy surgery in the United States each year.  It is by no means a small number.

Why are Episiotomies Performed?

This is the question that has been asked with increasing frequency, particularly in the United States, where episiotomies and Cesarean Sections have become all too commonplace.  The original rationale for the episiotomy is that it is thought to facilitate the birth process by enlarging the vaginal opening and increasing the speed and ease of delivery.  Episiotomies have been thought to reduce the damage resulting from natural tearing that can occur in childbirth.  However, women throughout the world and throughout the ages have been giving birth without the benefit of episiotomies.  As women become more empowered, and more educated regarding their birthing options, there is mounting evidence that the episiotomy causes more problems than it solves. Some of the most obvious concerns with the episiotomy include a higher incidence of post-delivery infection in the mother and the protracted healing and recovery process associated with an episiotomy.  

How is the Episiotomy Performed?

Episiotomies are typically performed using a pair of sterilized surgical scissors. The blade of the scissors is inserted into the vagina and snips are made downward toward the rectum to the desired length.  All of this is done under local anesthesia.

What Types of Episiotomies are Generally Performed?

The Median episiotomy is an incision made directly down from the lower vagina toward the rectum.

The other type of episiotomy is the Mediolateral episiotomy, which is made on a diagonal, not directly toward the rectum. This episiotomy can generally be made longer without the risk of tearing into the anus tissue during the birthing process. Unfortunately, this type of episiotomy generally takes longer to heal and is believed to be accompanied by a higher incidence of post-delivery infection.

What are My Options if I Don’t Want an Episiotomy?

To reiterate: women throughout the world and throughout the ages have been and continue delivering babies without the benefit (or hassle) of episiotomy.  While there may be a small number of childbirth cases that truly warrant an episiotomy, most mothers are capable of birthing without one.  Small tears are common in childbirth (even those where episiotomies are performed) and are believed to heal more quickly than an episiotomy. This is owing to the fact that an episiotomy incision slices through the entire pelvic floor, cutting through skin, muscle, and mucous membrane. Often the tears associated with childbirth are relatively minor and superficial by comparison.  Additionally, with a small amount of pre-delivery preparation, tearing can be minimized. There are a number of excellent exercises that can be performed several months in advance of a birth that will enhance the elasticity of the lower portion of the vaginal opening and reducing if not eliminating the probability of a tear.  Generally, the birthing process is extended by a couple of minutes if an episiotomy is not performed. This gives the obstetrician the opportunity to massage and apply warm compresses to the perineum, relaxing the perineal muscles immediately prior to delivery. With a little patience and finesse, a good caregiver is able to work the head out with a limited amount of tearing, if any. Again, by preparing in advance, you can dramatically improve your odds of birthing with minimal tearing.

 
What are the Advantages of NOT Having an Episiotomy?

Many women who don’t undergo episiotomies report much less post-delivery discomfort and more rapid healing of the perineum. Another significant advantage reported in the Bradley method of Childbirth is that delivering a baby over an intact perineum (one that has NOT been sliced open with an episiotomy) results in additional natural chest compression in the baby, causing fluid in the lungs of the newborn to be expelled during delivery.  This advantage alone seems well worth consideration in terms of the benefit to the well-being of the newborn baby.

Increasingly, obstetricians are taking a cue from midwives and other natural childbirth advocates and recognizing the fallacy and dangers of performing episiotomies without discretion.