![]() ![]() If your practitioner decides to do an episiotomy, she'll give you an injection of a local anesthetic and use surgical scissors to make a small, vertical cut in your perineum shortly before the birth of your baby. Include in your birth plan that you don't want an episiotomy unless it's necessary. Midwives have also provided much of the research showing how an episiotomy weakens the perineal tissue, increasing the risk of third- or fourth-degree laceration. Studies show that, as a group, midwives tend to do far fewer episiotomies than obstetricians. (Also ask about others in the practice, in case you end up with someone else at your delivery.) Talk to your practitioner early on about the procedure.Īsk how often and under what conditions he would perform an episiotomy, and how he might help you avoid tearing. How can I avoid an episiotomy if it's not necessary? In any case, your doctor will weigh the potential risks of the episiotomy against the potential benefits for your baby. However, heart rates usually recover, and there is usually ample time to allow for perineal stretching, so even in this instance an episiotomy would rarely be needed. If your baby is crowning and her heart rate is low, for example, an episiotomy might be done to allow for a faster delivery of the head. There aren't any specific scenarios when an episiotomy is clearly indicated, and in most instances your healthcare provider will try to avoid doing one. You're at risk of asymmetrical healing of the skin and other physical long-term results.You have an increased risk of tearing in the next birth, if they receive an episiotomy for their first vaginal birth.You're likely to have to wait longer before they have sex without discomfort.You're likely to have more pain during recovery.You're likely to lose more blood at the time of delivery.Tears that disrupt the anal sphincter make it more likely that the mom will have anal incontinence – trouble controlling bowel movements or gas. (These are known as third- or fourth-degree lacerations.) These serious tears result in more perineal pain after the birth, require a significantly longer recovery period, and are more likely to interfere with the strength of the pelvic floor muscles. You can tear further through both skin and muscle layers, including occasionally the anal sphincter.Research has shown that women with a spontaneous tear generally recover in the same or less time and often with fewer complications than those who had an episiotomy. Why is it better to tear naturally than to have an episiotomy? The Leapfrog Group, a nonprofit organization advocating positive healthcare in the United States, for example, has set a goal of an episiotomy rate of under 5 percent. (The number of episiotomies done for forceps or vacuum-assisted deliveries is significantly higher, though these have also showed a decline over time.) There are some experts, though, who think the number could be lower still. The incidence of episiotomies has been on the decline, from about 17 percent of vaginal births in 2006 to 7 percent in 2018. For this reason, the American College of Obstetricians and Gynecologists (ACOG) as well as a host of other experts now agree that the procedure shouldn't be done routinely. In fact, there is no good evidence that episiotomy offers your vaginal tissue and pelvic floor muscles any real protection, and the procedure may actually cause problems. Many experts also surmised that an episiotomy might help prevent later complications, such as incontinence.īut many studies over the past 20 years have shown that this is not the case. ![]() Obstetricians used to do episiotomies routinely to speed delivery and to prevent the vagina from tearing, particularly during a first vaginal delivery, in the belief that the "clean" incision of an episiotomy would heal more easily than a spontaneous tear. An episiotomy is a surgical cut in the skin between the vagina and the anus (the area called the perineum) meant to enlarge your vaginal opening just before the delivery of the baby's head.
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