Should You Have an Episiotomy During Delivery?

Episiotomy is a common intervention during childbirth, and is generally considered safe. Many doctors perform routine episiotomies as a general principle. However, as with any medical procedure, an episiotomy does carry some risk and may not be the right choice for every new mother.

Benefits of episiotomy

Episiotomy may shorten the pushing phase of labor by 5 to 15 minutes. This may be beneficial in cases of fetal distress, in which the baby needs to be out as quickly as possible in order to perform medical interventions (http://www.birthingnaturally.net/birthplan/intervention/episiotomy.html). In instances in which the perineum is not stretching properly to allow room for the baby, many doctors will perform an episiotomy in order to prevent tearing, asserting that an artificial cut is easier to repair than a spontaneous tear. (This is not necessarily true, as will be discussed in the next section.)

Risks of episiotomy

Any artificial cut carries an increased risk of infection, and episiotomies are no exception. While episiotomies are generally performed in order to prevent perineal tearing, the truth of the matter is that the procedure increases the mother's risk of severe tearing, including tearing into the sphincter. (According to http://www.pregnancy-info.net/breech_birth.html, episiotomy is one of the main risk factors for tears of this nature.) Most tears without an episiotomy are only first-degree and heal quickly, within a month after delivery. Episiotomy may also lead to increased discomfort during sex or a loss of sexual sensation (http://www.pregnancy-info.net/breech_birth.html). Some studies also suggest that episiotomy may contribute to postpartum incontinence. It is also important to note that many mothers receive episiotomies even when tearing is not imminent, simply because some doctors perform the procedure for every patient, regardless of need. These mothers subsequently must care for a wound that would not be present otherwise.

Preventing the need for an episiotomy and lowering the risk of a tear during delivery

There are a number of things a pregnant woman can do both during pregnancy and while in labor to prevent the need for an episiotomy and lessen her risk of a perineal tear during delivery. During pregnancy, Kegel exercises can help strengthen the muscles of the pelvic floor. (Kegels are well-advised for every pregnant woman, as they help prepare the pelvis for labor.) Perineal massage during pregnancy and labor can help improve elasticity and promote stretching of the perineum, lessening the risk of a tear. During labor, experiment with different laboring positions to decrease pressure on the perineum (squatting is a popular option, although not all doctors are willing to accommodate this position). Oil and massage, as well as warm compresses during labor, can also promote perineal stretching and elasticity. Instead of pushing on the doctor's command, spontaneous pushing dictated by the body's own natural cues can greatly reduce the risk of a perineal tear. In addition, local anesthetics should be avoided at all costs, as they can cause swelling and increase the risk of a tear. As noted above, a tear may be preferable to an episiotomy, as most tears are superficial and will heal rapidly. With some preparation, the risk of a deep tear is extremely low.

This is a very personal decision that should be carefully considered. Discuss your options with your doctor. Talk about natural ways to decrease your need for an episiotomy and to lower your risk of perineal tearing during delivery.

RESOURCES:

http://www.birthingnaturally.net/birthplan/intervention/episiotomy.html

http://www.gentlebirth.org/format/woolley.html

http://www.pregnancy-info.net/breech_birth.html

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