What the Heck is an Episiotomy?

Wondering what an episiotomy is? Here's what it is, why you may need one, and how to avoid them.

Ahh, the episiotomy. There are some things about having a baby that just make you go: “Seriously? No, seriously. I so didn’t sign up for that.”

Here are the nuts and bolts: an episiotomy is an incision made in the perineum – that fleshy area between the vagina and the anus. It speeds up delivery because the vaginal opening is that much bigger. Once the baby’s present and accounted for, the incision is stitched back up.

If you’re thinking “WTF?” you’re not alone.

But there are some very good reasons to have an episiotomy. Like, you find out you’re having a breech birth. Or maybe you’ve been pushing for several hours and you just…can’t…push…again. Sometimes that perfect child you’ve been dreaming about for nine frickin’ months pretty much refuses to budge and he needs a little encouragement – like forceps-or-the-vacuum kind of encouragement. Or very occasionally, your wee one can go into distress, where his heart rate shoots up or drops way down. It’s rare, but it happens.

In all those cases, your doc or midwife will very likely say it’s time to get the baby out and that means it’s time for an episiotomy. In all those cases, don’t hesitate.

But what if your delivery is chugging along just fine?

Is there any reason for you to have an episiotomy? Doctors – and many midwives – used to think so. They were trained to think that episiotomies help prevent and heal better than more extensive vaginal tears. The procedure was also thought to keep the bladder from drooping and the rectum from protruding into the vagina after childbirth. (Yep, you read that right. Drooping bladder. Protruding rectum.)

Here’s the problem: there isn’t any evidence to suggest episiotomies do any of that. It’s now generally accepted that a routine episiotomy – not one done for any of our “good reasons” – does not provide any significant benefit, either right after delivery or in the months that follow. Some medical-types thought that recovering from an episiotomy might hurt less than from a tear, but that’s not backed up by any evidence. There isn’t even any proof that having an episiotomy will prevent your insides from ending up on the outside. Ain’t that the shits?

So how do you avoid one, if you can?

Lots of people recommend massaging the perineum during your pregnancy. Now, I’m all about a good massage, but studies suggest this is only really effective for first-time moms. There isn’t much of a consensus on how long to do it either, but 10 minutes a day from 35 weeks on seems to be a common recommendation. If you’re into it, I say go for it. It can’t hurt.

You can also try applying warm compresses to the perineum during the pushing stage of labor. This may help soften the tissue and make it easier for the baby to head on out. Some health care providers also massage the area as labor progresses.

You might also want to give some thought to who’s going to deliver your baby, if you haven’t already decided. Studies show that midwives do fewer episiotomies, while older doctors do the most. Weirdly, more episiotomies are performed in the middle of the day than the middle of the night. Maybe it’s because doctors have more stuff to do during the day so they want to speed things up a bit.

But the most important thing you can do is talk to your health care provider. Ask them how often they do episiotomies and under what circumstances. Remember, though, it’s important to go into labor with an open mind. Sometimes things don’t go as planned and you have to make decisions on the fly.

WTF is an episiotomy anyway?! If you're pregnant, you should know what this is and how to avoid one, if possible. Our babies never know the things we do for them! #episiotomyhealing #episiotomycare #episiotomyversustearing #postpartumrecovery

Related: How to Make a Padsicle: Easy Instructions for Postpartum Cold Packs
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What the Heck is an Episiotomy?

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  • I had to get an episiotomy because I was going to tear and my doctor believes it is easier to stitch up and heal than a tear. I think I agree because my friend tore and it took forever for her to heal and it hurt a lot, mine wasn’t that bad.

  • There is no evidence that an episiotomy reduces the risk of perineal injury, improves perineal healing, prevents birth injury in babies, or reduces the risk of future incontinence.

    Episiotomies are more painful after birth, and actually heal worse than natural tears. It can actually increase the risk of worse tearing.

    Often, they are done when a baby becomes "stuck" at the pubic bone (e.g. shoulder dystocia). That is not a perineal tissue problem, it is a bone problem, and cutting the skin does not really help.

    Often, docs prefer an episiotomy because it is faster to suture than a tear because it is a straight line. If a doc starts giving you excuses on why he/she does episiotomies that are anything other than "in an emergency," I would find a new doctor (or at least heartily refuse the procedure)!

  • I had a level 4 episiotomy. I pushed for 3 hours and I was exhausted. The Dr. said "Do you want her out" and I said "Yes." He cut me and she popped right out. I didn’t even know that was what he was going to do! Anyway, it doesn’t bother me that I had one. Luckily I had purchased Mother Love Sitz Bath and I sat in that every night before I went to bed. I went to my 6 week check up and the Dr. said it didn’t even look like I had a level 4 episiotomy! They couldn’t even tell. I really do believe the sitz bath helped me heal!

  • I had two episiotomies and tore with my third. Weirdly, the tear healed so much better/faster than the episiotomies. It hurt worse in the moment but yeah, way preferred it to the incision and I can only assume it was more superficial. Unless they think it’s going to be a major tear, try and avoid the snip.

  • Episiotomy – that word makes me shiver. With my son (my 1st child), I was having a hard time pushing and we had to use the vacuum and I had an episiotomy. I got concerned when the resident was stitching me up and it felt like it was taking forever….I was right to be concerned as I discovered 6 months later that my episiotomy didn’t heal well and I had to have a revision episiotomy. That’s right, I had 2 episiotomies for one child. The OB warned me that I would likely have to have a c-section with any future kids. I would recommend finding out what duties residents can perform and what say you have…or get a doula. Because going through the healing process of a second episiotomy is just not worth the upfront effort.

  • I had to have an episiotomy with my daughter (first child) as I was hemorrhaging and they needed the baby out quickly. I had been pushing for 20 minutes and actually had her almost all the way out anyway, so to be honest, it didn’t seem all that terrible (the hemorrhaging DID, so I guess the episiotomy just seemed minor at the time). One recommendation I would make is to get some pelvis floor physio post birth. I did this after a few months, and it made a world of difference. I now feel like myself again and don’t have any lingering pain or other issues.

    As always – great article!

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