What the Heck is an Episiotomy?

Ahh, the episiotomy. There are some things about having a baby that just make you go: “Seriously? No, seriously. I so didn’t sign up for that.”

Here are the nuts and bolts: an episiotomy is an incision made in the perineum – that fleshy area between the vagina and the anus. It speeds up delivery because the vaginal opening is that much bigger. Once the baby’s present and accounted for, the incision is stitched back up.

If you’re thinking “WTF?” you’re not alone.

But there are some very good reasons to have an episiotomy. Like, you find out you’re having a breech birth. Or maybe you’ve been pushing for several hours and you just…can’t…push…again. Sometimes that perfect child you’ve been dreaming about for nine frickin’ months pretty much refuses to budge and he needs a little encouragement – like forceps-or-the-vacuum kind of encouragement. Or very occasionally, your wee one can go into distress, where his heart rate shoots up or drops way down. It’s rare, but it happens.

In all those cases, your doc or midwife will very likely say it’s time to get the baby out and that means it’s time for an episiotomy. In all those cases, don’t hesitate.

But what if your delivery is chugging along just fine?

Is there any reason for you to have an episiotomy? Doctors – and many midwives – used to think so. They were trained to think that episiotomies help prevent and heal better than more extensive vaginal tears. The procedure was also thought to keep the bladder from drooping and the rectum from protruding into the vagina after childbirth. (Yep, you read that right. Drooping bladder. Protruding rectum.)

Here’s the problem: there isn’t any evidence to suggest episiotomies do any of that. It’s now generally accepted that a routine episiotomy – not one done for any of our “good reasons” – does not provide any significant benefit, either right after delivery or in the months that follow. Some medical-types thought that recovering from an episiotomy might hurt less than from a tear, but that’s not backed up by any evidence. There isn’t even any proof that having an episiotomy will prevent your insides from ending up on the outside. Ain’t that the shits?

So how do you avoid one, if you can?

Lots of people recommend massaging the perineum during your pregnancy. Now, I’m all about a good massage, but studies suggest this is only really effective for first-time moms. There isn’t much of a consensus on how long to do it either, but 10 minutes a day from 35 weeks on seems to be a common recommendation. If you’re into it, I say go for it. It can’t hurt.

You can also try applying warm compresses to the perineum during the pushing stage of labor. This may help soften the tissue and make it easier for the baby to head on out. Some health care providers also massage the area as labor progresses.

You might also want to give some thought to who’s going to deliver your baby, if you haven’t already decided. Studies show that midwives do fewer episiotomies, while older doctors do the most. Weirdly, more episiotomies are performed in the middle of the day than the middle of the night. Maybe it’s because doctors have more stuff to do during the day so they want to speed things up a bit.

But the most important thing you can do is talk to your health care provider. Ask them how often they do episiotomies and under what circumstances. Remember, though, it’s important to go into labor with an open mind. Sometimes things don’t go as planned and you have to make decisions on the fly.