all about episiotomies

great title, huh!

an episiotomy is a surgical cut to a woman's perineum, performed during vaginal childbirth.

this practice used to be quite routine, as many deliveries were assisted by forceps.

according to a Centers for Disease Control’s 2001 study, forcep deliveries have decreased from a rate of 17.6 percent of all deliveries in 1980 to only four percent of all deliveries in the year 2000. episiotomy rates, however, have not followed this same trend. episiotomies have dropped to 32.7 percent of all deliveries versus 64 percent in 1988.

so if forcep deliveries are now less common, why would doctors still routinely give episiotomies? many doctors believe that episiotomies prevent damage to the perineum. however, studies show no evidence that the pelvic floor muscles would be "protected" by an episiotomy.

there are risks involved with episiotomies, such as infection, increased bleeding, hematoma, postpartum pain, damage to the anal sphincter, incontinence, increased scar tissue, loss of sexual sensation, and painful intercourse, among others. studies have shown that women who tear naturally return sooner to sexual intercourse after giving birth than women who receive episiotomies.

an episiotomy can be beneficial in a vaginal delivery because it speeds up birth. this is helpful when a baby is truly in distress. however, if the baby or the mother's life is not in danger, there are more risks to receiving an episiotomy than to letting the body take its natural course, even if some tearing occurs.

think of the vagina as a ribbon. when you cut a ribbon and then tear, what happens? lots and lots of fraying. it can be the same way when you receive an episiotomy. having an episiotomy does not mean you will not tear - in fact, if you do tear after an episiotomy, the results are usually much worse (like the ribbon example). when you try to tear a ribbon without making a cut, there is not as much fraying. it is like that when you tear without an episiotomy - a cleaner, often smaller tear occurs which is better for healing and longterm perineal health.

as with all interventions, there are risks and benefits. the time to research these interventions is while you are pregnant - find out why they are done, what the risks are, and talk to your doctor or midwife about it. most importantly, make sure you are well informed so that you can avoid any interventions that are unnecessary. 

tips on avoiding an unnecessary episiotomy or excessive tearing:
1. become educated on the topic - know the pros and cons
2. push slowly and controlled (as much as you can control that overwhelming urge!), allowing your skin time to stretch (the "ring of fire" happens for a burns which is your body telling you to slow down and allow it time to stretch...listen to your body!)
3. know your caregiver's opinion on episiotomies - if your caregiver has a high episiotomy rate, consider finding someone else who uses them infrequently
4. do kegel exercises to strengthen your pelvic floor
5. in the last few weeks of pregnancy, do perineal massage to help stretch the opening
6. during pushing, ask that your doctor/midwife/nurse places support on your perineum to redirect pressure and ease the possibility of tearing (hot compresses and oil do wonders for this)
7. birth in a position other than on your back with your legs in stirrups - this position places a lot of unnecessary pressure on your perineum, thus increasing the possibility of tearing/use of episiotomy
8. birth naturally - when you birth naturally, you are in control of your body - chances of receiving an episiotomy go up with the administration of epidural anesthesia because pushing can be more difficult when numb