Episiotomy

What is Episiotomy?

Episiotomy is a surgical cut that is made to the perineal skin (at the base of the vagina) during the pushing stage of labor. There are two main types of cuts. A midline episiotomy is cut straight down towards the anus. A mediolateral is cut to the side.

The cut made by an episiotomy is equivalent to a second degree tear, meaning that both skin and muscle are cut.

Why choose an episiotomy?

In cases of fetal distress, an episiotomy may shorten pushing by 5 to 15 minutes allowing for the baby to be born faster.

If the perineum is not stretching, some health care providers will recommend an episiotomy.

Risks of Episiotomy

• Episiotomies cause increased pain during recovery. The average length of healing time for an episiotomy is 3 months, compared to 1 month with a tear.

• Episiotomies increase the incidence of deep tears into the anal sphincter.

• Because skin is cut, there is an increased risk for infection.

Other Options to Consider

• Some women prefer to try their luck for a tear, knowing that the average tear is only a first degree (meaning only skin is cut) and heals in about a month.

• Choose positions that speed labor and reduce the incidence of pelvic floor problems such as squatting.

• Because the idea is not to "avoid and episiotomy" but to avoid damage to the perineum, you may want to try:
  Perineal massage during pregnancy which can help the mother learn to relax rather than tense during the burning and stretching sensations that accompany crowning.
  Pelvic Floor Exercises during pregnancy to make the pelvic floor stronger and more elastic.
  Spontaneous Pushing, where you push only as strong as your body says is necessary for only when your body gives you the urge.
  Warm compresses to encourage the stretching of the perineum.
  Avoid a Local Anesthetic which will cause the perineal tissues to swell decreasing the flexibility and increasing the chance of a tear.
  Use oil and massage on the perineum as the baby is crowning to promote stretching.

For more information about episiotomies

Research review on episiotomy from Henci Goer.

Robbie Davis-Floyd discusses episiotomies as part of the Birth Messages in her work Birth as an American Rite of Passage.

You May Also Be Interested In: What changes are being assessed during a cervical exam. The Natural Childbirth Directory can help you find more information about birth and locate childbirth professionals. The Coach's Notebook helps you learn tools and techniques to manage labor. Do some self exploration to discover how you will act in labor. Find out how exercise and nutrition can help you achieve your birth plan goals.

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