Episiotomy 101: What You Need to Know (Without Squirming Too Much)
Ah, childbirth—the beautiful, magical, life-altering process where you bring a tiny human into the world. It’s also when you hear medical terms that sound like they belong in a medieval torture manual. One of those words? Episiotomy. So, what is it? Should you be worried? Let’s break it down with science, stats, and just enough humor to keep it tolerable.
✂️ What Is an Episiotomy?
An episiotomy is a surgical incision made in the perineum (the area between the vagina and the anus) during childbirth. The goal? To widen the vaginal opening and speed up delivery if needed. Think of it like snipping the edge of a gift bag to fit an oversized present—except, you know, significantly less festive. 🎁
📉 Episiotomies: Once Common, Now Less So
Back in the day (aka the 1970s and 80s), episiotomies were routine, with 60–80% of vaginal births involving the procedure [source]. The logic? Doctors believed it would prevent more severe, natural tearing.
Turns out, that was not exactly true. Research has since shown that routine episiotomies actually increase the risk of severe tearing and other complications. As a result, only about 7-12% of births involve episiotomies today in the U.S. [source].
🏥 When Is an Episiotomy Still Used?
While it’s no longer routine, there are still some valid reasons why a healthcare provider might recommend an episiotomy:
👉 Baby in distress – If the baby’s heart rate drops and quick delivery is necessary.
👉 Instrument-assisted birth – If forceps or a vacuum extractor are needed to help baby out.
👉 Shoulder dystocia – When the baby’s shoulders get stuck after the head is delivered.
👉 Severe perineal tightness – If the tissue isn’t stretching enough, increasing the risk of serious tearing.
In these cases, an episiotomy can prevent longer, more traumatic tears that could impact pelvic floor function and recovery.
✂️ Types of Episiotomies (Because, Yes, There Are Types)
🔹 Midline Episiotomy – A straight cut from the vaginal opening toward the anus. It’s easier to repair but has a higher risk of extending into a severe third- or fourth-degree tear.
🔹 Mediolateral Episiotomy – A diagonal cut at an angle. Less risk of extending into the anus, but more painful to heal.
✅ Pros & ❌ Cons of an Episiotomy
✔️ Pros:
Can speed up delivery in an emergency.
May prevent severe, jagged tears in some cases.
Helps when forceps or vacuum extraction are needed.
❌ Cons:
Longer healing time compared to natural tears.
Increased pain and potential for infection.
Possible scar tissue and long-term discomfort (e.g., painful sex postpartum).
May weaken pelvic floor muscles, increasing risk of future issues like incontinence.
💬 Do You Have a Say? (Short Answer: YES!)
If the thought of an episiotomy makes you sweat, talk to your provider ahead of time. Some OB-GYNs and midwives rarely perform them, while others are more open to using them.
Questions to ask your provider: ✔️ “What’s your rate of performing episiotomies?” ✔️ “Under what circumstances would you recommend one?” ✔️ “How do you support natural tearing over episiotomy?”
Many people include episiotomy preferences in their birth plan, and while labor doesn’t always go according to plan (understatement of the century), it helps to set expectations.
🚫 How to Reduce the Chances of an Episiotomy
While there’s no guaranteed way to avoid an episiotomy, these practices may help:
👉 Perineal massage – Starting a few weeks before birth can increase tissue flexibility.
👉 Warm compresses during labor – Increases blood flow and elasticity.
👉 Controlled pushing – Letting your body guide you instead of forceful, sudden pushes.
👉 Laboring in upright positions – Gravity is your friend! Positions like squatting or hands-and-knees may reduce perineal strain.
🩹 The Aftermath: What If You Get One?
If you do end up with an episiotomy, here’s what to expect:
🧵 Stitches – Dissolvable stitches will be used to close the cut.
😣 Healing – Expect soreness and discomfort for a few weeks.
🧊 Care Tips:
Ice packs to reduce swelling.
Peri bottle to rinse after bathroom trips (because wiping is not happening).
Witch hazel pads for extra soothing power.
🎤 Final Thoughts: It’s Your Body, Your Birth
Yes, the thought of an episiotomy might make you wince, but knowledge is power. It’s just one of many tools in the childbirth toolbox, used only when necessary. The most important thing? Feeling informed and supported in whatever happens.
And hey, no matter how your baby makes their grand entrance—you’re a rockstar. ⭐
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