Episiotomy. The word strikes fear into the hearts of pregnant women everywhere. But many women are actually not all that sure about how or why they’re done or if there is any way to avoid them. Let’s learn!
Estimated reading time: 5 minutes
An episiotomy is an incision made in the perineum to enlarge the vaginal outlet. In other words, it’s a cut that’s made in the skin between your vagina and anus in order to make more room for baby’s head to come through. A midline episiotomy begins at the center of the perineum and extends straight down towards the anus. A mediolateral episiotomy is cut at a 45 degree angle, which points downward to the right or left of the perineum (1).
(Just in case you’re wondering what your perineum is, it’s the area between the vagina and anus.)
Back in the day, episiotomies were given routinely to women just before birth to help speed up the pushing phase. This is an outdated practice that has, in many cases, proven no benefit. Today, the use of episiotomies is restricted only to situations where it is medically necessary, such as:
Factors that are associated with a higher rate of episiotomies include (1):
An episiotomy makes it more likely that a woman will suffer deep perineal tears. Major perineal trauma — a 4th degree tear that extends to the muscles of the anus — is significantly more likely to happen with a midline episiotomy. Also, episiotomies make it more likely that repeat trauma to the perineum will occur in future births.
Episiotomies are associated with additional complications such as blood loss and infection. They cause perineal discomfort that can last for weeks past birth, as well as painful sex.
If you are planning a natural birth, you are probably eager to know if episiotomies hurt. Surprisingly, many women say that they didn’t feel pain when the incision was initially made. As baby’s head descends into the birth canal, the muscles of the perineum stretch and thin out. Muscle that was once 5 cm thick becomes less than 1 cm thick. This thinning results in a decrease of blood flow to the area, which results in a natural anesthesia.
However, it would be grossly inaccurate to say that episiotomies don’t hurt. There is significant discomfort associated with the incision in the days and weeks following the birth. Perineal swelling and tenderness can make walking, sitting, and using the bathroom painful experiences (4). Additionally, the stitches can tug when moving and cause an unrelenting itch while healing. (Learn how to care for perineal tears and incisions.)
Here are some general tips to help reduce your chance of an episiotomy:
Most women are going to experience some minor lacerations on the perineum during pushing. When they occur naturally, it is known as “tearing.” When compared to a routine episiotomy, tearing has been found to be less painful. It is also less traumatic to the perineal tissue. Tears also heal better than episiotomy lacerations (5).
Kopa Birth’s online birthing classes allow you to prepare for natural childbirth in the comfort of your own home, 24/7. Enroll today in our free online childbirth class to learn more about preparing for natural childbirth.
References:
Episiotomy. The word strikes fear into the hearts of pregnant women everywhere. But many women are actually not all that sure about how or why they’re done or if there
