Chances are, you probably know enough about episiotomies — where an incision is made in the perineum to enlarge the vaginal opening and make room for baby's grand entrance — to know that you'd rather not have one. But you may be wondering whether you'll heal faster after having an episiotomy or a natural tear during labor.
Episiotomy vs. natural tearing
Research has shown that moms seem to do better without an episiotomy, with less risk of infection, blood loss (though there is still risk of blood loss and infection with natural tears), perineal pain and incontinence as well as faster healing.
What's more, episiotomies are more likely than spontaneous tears to result in third- or fourth-degree perineal tears, where the tear passes through to the rectum — taking longer to heal and sometimes causing fecal incontinence.
Until pretty recently, midwives and doctors routinely made the cut under the assumption that episiotomies protected women from spontaneous tears that were more difficult to heal and could lead to problems like urinary incontinence down the line. Doctors also feared that newborns faced birth trauma from the head pushing for too long against the perineum.
However research has debunked these theories, showing that both moms and newborns fare as well if not better without an episiotomy. These days, episiotomies are generally not performed as often. After the American College of Obstetricians and Gynecologists (ACOG) recommended against their routine use, the rate of delivering moms who got one dropped by more than 20 percent over the previous decade — from 33 percent of vaginal births in 2000 to about 12 percent in 2012, according to the latest statistics.
When should an episiotomy be performed?
That said, there is still a place for episiotomies in some birth scenarios, such as when baby's head is too large and needs more room to exit, when forceps or vacuum delivery needs to be performed or, in the case of shoulder dystocia, when a shoulder gets stuck in the birth canal.
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In most cases, tearing is something you can work to avoid. During pregnancy, do your Kegels — those do-anywhere pelvic-muscle movements — which will help tone up the area and prevent urinary leakage. Perineal massage can also stretch the area out in the weeks before labor as well as during delivery.
During labor, your health care provider will likely apply warm compresses on your perineal area to relax the muscles. A standing or squatting position while you're laboring lets gravity work in your favor. And exhaling or grunting can help with the pushing.
While baby's head is emerging, your delivery team may also apply counterpressure to better control delivery and reduce the risk of tearing.
So if you haven't already, discuss the possibility of an episiotomy with your doctor. It's very likely that he or she will agree the procedure shouldn't be performed without good reason.
Just keep in mind that the final decision should be made by your health care provider at the time of delivery, when that little head is crowning.
Happy delivery!
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