Episiotomies: An Overview

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Definition

An episiotomy is a minor surgical procedure which widens the birth canal by cutting the introitus (vaginal opening). Episiotomy is performed to prevent the jagged, less controlled tearing of the introital tissue during the stretching associated with delivery.

The routine use of an episiotomy may cause more problems than it solves and has been linked to increased rectal tearing. It is a painful procedure that may predispose to infections and other complications. An episiotomy may be very helpful when forceps or vacuum extraction are used and with breech presentations. Talk to your doctor about whether you might need one. The use of episiotomies has decreased in the past few years.

The Research

A 1994 Canadian study found that spontaneous tears were less painful for women than episiotomies, and that women who avoided an episiotomy had stronger pelvic floor muscles three months after giving birth.

Numerous studies have concluded that episiotomies should not be done without a good medical reason because possible complications, such as rectal injury and muscle damage, can outweigh the short-term benefits.

Avoiding a Tear

Preparing your perineal tissues for the stretching of birth with perineal massage and Kegel exercise, the less they will tear, and the better they will heal. Midwives report that women who practice perineal massage daily in the last six weeks of pregnancy experience less stinging sensation during crowning. Mothers with a more conditioned perineum are less likely to tear or get an episiotomy. An added value of perineal massage is that it familiarizes a woman with stretching sensations in this area so she will more easily relax these stretching muscles when stinging occurs just before the moment of birth.