Labor & Delivery: Tearing vs. Cutting

For many women, the decision of whether they should tear or request an episiotomy during delivery never crosses their minds. Many doctors, especially those who have been practicing for many years, routinely perform episiotomies. Cutting to make way for a baby to enter the world has been standard medical practice for the past several decades. Only in recent years, with the resurgence of midwives and free-thinking physicians, has doubt been cast on the necessity and benefits of routine episiotomies.

Are Episiotomies Necessary?
Though many doctors with hundreds of births under their belts would say "Yes", many others are quick to disagree. The purpose of an episiotomy is to provide room for the baby to pass out of the vagina, without causing the woman's vagina to tear.

The benefits to an episiotomy are said to be:
1. Preventing the vagina from tearing
2. Reducing the risk of incontinence
3. Quicker healing
4. Speeding up the birth

Negative side effects include:
1. Infection
2. Increased pain
3. Longer healing times
4. Increased pain when intercourse is resumed
5. Higher occurrence of 3rd and 4th degree vaginal tears

What is the Alternative?
It should be mentioned that not all women will need to have an episiotomy or else face a vaginal tear. Some women have very elastic vaginal tissue, which can withstand childbirth without tearing or needing to be cut. However, the vast majority of first time mothers will need to face this decision.

Some ways to prevent needing an episiotomy or tearing, as advocated by midwives are:
1. Adequate nutrition (healthy skin stretches more easily)
2. Kegel exercises during pregnancy
3. Discussing your concerns with your physician
4. Perineal massage during pregnancy
5. Controlled pushing, which allows more time for your tissues to stretch
6. Warm compresses during labor
7. Manual stretching by the physician/midwife during delivery

The Argument for Tearing
Obstetrical opinion has been gradually shifting from episiotomies to natural tearing in recent years. Many physicians who have typically cut women, now see the value in attempting to stretch the vaginal tissue during labor. Also, many women have been receiving more education about pregnancy and childbirth and have opted to take their chances with tearing. The preference for tearing is based on the belief that a woman's body will only tear as much as is necessary for a baby to pass out of the vagina. Rather than a cut, which is made by the judgment call of the doctor, the vaginal tissue may tear much less than the cut that would have been made. It has also been pointed out that if a straight line is cut for the woman, there is a greater risk that the force of the baby's head could cause this cut to extend beyond its intent, whereas a natural tear is more controlled. It has also been noted that natural tears heal more fully than episiotomies. Since the skin will not tear in a straight line, the different ridges in the skin will grow together to form a tighter, more cohesively healed area.

Making Your Decision
The key to making your decision often comes down to the opinion of your doctor or midwife. If you prefer to tear, you need to find a doctor who sees the benefits of stretching vaginal tissue and preventing an episiotomy. If your doctor has routinely cut episiotomies for decades, he may bristle at your request that he change methods. Likewise, if the idea of tearing frightens you, discuss the episiotomy procedure with your physician during pregnancy.

The most important factor in making your decision is that you feel that you have made the best one based on your information. If you spend some time reading and discussing these things with your doctor or midwife, you will feel more comfortable with, and empowered by, your decision.