Do You Need an Episiotomy to Give Birth?

USA, Utah, Payson, Man assisting childbirth in hospital
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An episiotomy is a surgical incision in the area of skin between the vagina and the anus (perineum). It is made by your obstetrician or midwife when your baby is close to being delivered to make more room in the back part of your vagina.

There are two different types of episiotomy. A midline episiotomy is a cut made in the perineum down toward the anus. A mediolateral episiotomy is a diagonal cut to the side of the perineum that helps prevent the incision from extending into the rectum.

The American College of Obstetricians and Gynecologists (ACOG) states that the best available evidence does not support routine use of episiotomy.

Why Episiotomies Are Used

Research has demonstrated that episiotomy increases the risk of third and fourth degree lacerations of the perineum. That being said, in certain situations your obstetrician or midwife may feel that an episiotomy is indicated, such as:

Side Effects 

You may want to discuss episiotomies with your obstetrician or midwife during one of your prenatal appointments so you can learn more about how they use them, as well as what to expect in the event you need one.

The following are reported side effects of an episiotomy:

  • Infection
  • Increased pain
  • Increase in 3rd and 4th-degree vaginal lacerations (euphemistically called extensions)
  • Longer healing times
  • Increased discomfort when intercourse is resumed

Although a surgical incision may not be required during your childbirth, it is highly likely that you will experience some kind of laceration to your vagina or perineum as your baby delivers.

Prevention

Luckily there are some things you can do to help reduce your risk of a significant perineal laceration. Some preventative measures you can take include:

  • Proper nutrition (healthy skin stretches more easily)
  • Kegels (exercises for your pelvic floor muscles)
  • Prenatal perineal massage
  • Warm compresses, perineal massage, and support during delivery

A Word From Verywell

An episiotomy is not always necessary, but there are situations where it can be an important intervention.

Having good communication with your healthcare practitioner will help you know your own body, understand your rights as a patient, and become informed about what the procedure entails.

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Article Sources
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  1. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal DeliveryObstet Gynecol. 2016;128(1):e1–e15. doi:10.1097/AOG.0000000000001523‌

  2. Woolner AM, Ayansina D, Black M, Bhattacharya S. The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish womenPLoS One. 2019;14(4):e0215180. Published 2019 Apr 11. doi:10.1371/journal.pone.0215180

  3. Royal College of Obstetricians & Gynaecologists. Perineal tears during childbirth. Updated January 22, 2020.

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