Many expectant mothers prefer a natural birth due to its many benefits for both the baby and the mother. However, there’s often concern about the need for an episiotomy, with some even saying that "nine out of ten women have an episiotomy." But is this really true? Let's dive into what episiotomy really is and when it’s necessary.
What is an Episiotomy?
An episiotomy is a surgical incision made in the perineum—the area between the vagina and the anus—during childbirth to enlarge the vaginal opening. There are two main types: one is a median episiotomy (straight down the middle), and the other, known as a “lateral” or “side” episiotomy, is made at a 45-degree angle either to the left or right. This procedure is usually done to assist in the delivery, making it easier for the baby to pass through.
Is Episiotomy Required for All Natural Births?
While an episiotomy can make delivery easier and help avoid more severe tearing, it's not always necessary. In fact, many health organizations, including the World Health Organization (WHO), now recommend limiting episiotomy use. The WHO specifically advises against routine or unnecessary episiotomy, and similar guidelines are followed in many modern hospitals.
Despite its common association with natural births, episiotomy is a controlled procedure and should only be performed when there are specific medical indications. This makes it clear that episiotomy is not as widespread as people often think, and it’s not something that will automatically happen during every birth.
When is Episiotomy Performed?
Doctors generally try to avoid episiotomies and will only consider it under specific conditions, such as:
- Difficult delivery progress: When labor is delayed, or there are concerns about the baby’s health (e.g., fetal distress or slow heart rate).
- Large baby size: If the baby is too large, it may be harder for the baby to pass through the birth canal without assistance.
- Tight perineum: If the perineum is too tight or lacks elasticity, it may tear during birth, and an episiotomy can help prevent this.
- Use of assisted delivery tools: If forceps or a vacuum extractor is needed to help guide the baby’s head out, an episiotomy might be performed to make more room.
Before labor, it's helpful to talk to your doctor about your birth plan, including whether an episiotomy might be recommended in your case. Understanding the hospital’s approach to episiotomy can ease some concerns.
Does Episiotomy Hurt?
A common fear about episiotomy is the pain. In reality, the procedure is usually done under local anesthesia, so you will not feel pain during the incision itself. Most women report feeling much more discomfort from contractions or the pressure of the baby’s head against the perineum than from the episiotomy.
The post-delivery stitching of the episiotomy site may cause some discomfort as the anesthesia wears off, but this can be managed with pain relief. Some women describe the pain as mild, similar to a mosquito bite, especially compared to the intense discomfort of contractions.
How Long Does It Take to Heal from an Episiotomy?
One advantage of episiotomy over natural tearing is that the cut is more controlled, making it easier to repair. The recovery time is generally shorter, and most women see visible healing within 5 to 7 days. Deeper healing takes longer, usually around 7 to 14 days.
In terms of long-term impact, once the wound is fully healed, most women report no lasting effects on sexual activity. However, some women may feel slight discomfort for a few months after delivery, which typically resolves as healing completes.
Can You Avoid Episiotomy?
While it's not always possible to prevent an episiotomy, there are some strategies to reduce the likelihood:
- Maintain a healthy weight: Keeping your weight in check during pregnancy can help prevent a large baby, which may reduce the need for an episiotomy.
- Practice perineal massage: Gently stretching the perineum in the weeks leading up to delivery can increase its elasticity and reduce the chances of tearing or needing an episiotomy.
- Exercise: Regular pelvic floor exercises, yoga, and walking can strengthen the muscles needed for labor, which may help with a smoother, less intervention-heavy birth.
- Follow proper pushing techniques: Listening to your doctor and midwife’s guidance during the pushing phase can help ensure that the perineum doesn’t tear and that an episiotomy is not necessary.
While the idea of an episiotomy can be unsettling, it’s important to remember that it is only performed when absolutely necessary for the safety of both the mother and the baby. Discuss your concerns with your healthcare provider, and remember that modern medical guidelines emphasize minimizing unnecessary interventions during childbirth.
