Episiotomy

An episiotomy is a surgical cut your doctor may make in the muscular area between your vagina and anus just before delivery to enlarge your vaginal opening. Doctors generally perform episiotomies to speed delivery and prevent the vagina from tearing, especially during a first vaginal delivery. Episiotomies used to be a routine part of vaginal deliveries and many experts believed that the clean incision of an episiotomy would heal more easily than a spontaneous tear. However, a large number of studies over the last 20 years have disproved this theory and the number of episiotomies is declining.

An episiotomy may be medically necessary if:

• Your baby's heart rate shows that he or she isn’t tolerating labor well and needs to be born as quickly as possible.

• If your baby is very large and your doctor needs additional room to manipulate him or her through the birth canal.

• If your doctor needs additional room when using forceps to deliver your baby.

The most common type of episiotomy in the United States and Canada is the midline, second degree episiotomy, which runs in a straight line midway between the vagina and anus. Mediolateral episiotomies, when the cut runs diagonally to one side or the other, are more common in other parts of the world. The most traumatic, and rare, episiotomies are fourth degree and extend through the rectum.

Approximately 40 percent of vaginal deliveries in the United States include an episiotomy. Although between 1980 and 1998 the rate of episiotomies in the United States dropped 39 percent, it is still one of the most frequent surgical procedures performed on women in the United States.

Doctors once thought that an episiotomy would prevent deep, ragged, uncontrolled tears in the perineum. However, research has shown that episiotomies often cause, not prevent, tears. And women with spontaneous tears generally recover in the same or less time and often with less pain and fewer complications than those with episiotomies. Women who get episiotomies are more likely to end up with serious, deep tears that go close to or through the rectum. Tears that go through the rectum result in more perineal pain after delivery, require a significantly longer recovery period, are more likely to weaken the pelvic floor muscles, result in anal incontinence, and cause more discomfort when sex is resumed.

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