Labor And Birth | Should I Refuse An Episiotomy?

Once a routine procedure during hospital vaginal births, episiotomy is now being questioned more and more by patients and health professionals alike. In fact, the general consensus after about twenty years of research is that episiotomy is not necessarily indicated in all births as a routine procedure.

What Is an Episiotomy?

During a vaginal delivery, the doctor may make an incision or cut between the base of the vaginal opening and the anus. This elastic tissue is known as the perineum. The doctor then stitches the incision after the birth. Local anesthetic is used to numb the area.

What Are the Pros of an Episiotomy?

Some of the pros are now up for debate; but generally speaking, episiotomy pros include the following.

* Prevention of incontinence – anal and bladder

* Increased vaginal “tightness” to enhance sexual pleasure after the birth

* Strengthening of pelvic floor muscles which may decrease the chances of bladder and/or uterine prolapse

* Less healing time than a natural tear

* “Clean” surgical wound rather than a “messy” tear

* May hasten the delivery, which can help if the baby is in distress and needs to come out quickly

* Allows more “room” for the doctor to manipulate a baby that is positioned badly

* Reduces pushing time

What Are Some of the Cons of an Episiotomy?

Ironically, some of the cons of episiotomies address the very same issues. These include the following.

* Bladder and anal incontinence may be caused or worsened

* Vaginal tightness and scar tissue may make sexual intercourse painful for weeks or months following the birth

* A cut in the perineal tissue may increase tearing (it’s not unlike a piece of paper – if you pull on it, it is less likely to tear than if you put a small cut at the top of the paper and then pull)

* A straight, surgical cut may be harder to stitch up than a tear (again, think of a piece of paper – torn edges can be match up like puzzle pieces, but straight edges are very hard to put back together exactly the same)

* Some studies show that episiotomies heal more slowly and are more painful during healing than tears

* An episiotomy may be more likely to succumb to infection than a tear

* Scar tissue from an episiotomy may make sexual intercourse painful, and may increase the likelihood of a severe tear during the next birth

* Cutting into deep tissue in the area traumatizes tissue that is not injured in a natural tear

So when is an episiotomy indicated? Most practitioners agree that episiotomy is indicated when a natural vaginal delivery is not progressing, or the mother’s perineal muscles are so rigid that there is the risk of a significant tear. However, the latter indication for episiotomy, as noted above, is that tissue that is cut may be more likely to tear further on.