An episiotomy is an incision in the perineum (the area between the vagina and the anus) made just before the time of birth in order to enlarge the vaginal opening and prevent spontaneous tearing. The incision is stitched closed under local anesthesia after the baby has been delivered.
The number of American mothers getting episiotomies has decreased from 64 percent to 39 percent in the last 20 years. But many experts say the current figures are still too high.
There are cases where an episiotomy can be beneficial: to hasten the delivery of a baby in trouble, ease a breech birth, enlarge a too-tight vaginal opening, or prevent painful tearing toward the front of the vagina.
But most of the time, with local massage and control of the delivery, the vaginal tissue will stretch and then return to normal on its own. And if natural tears occur, they typically require less extensive stitching than an episiotomy.
A review of existing studies published in Obstetrics & Gynecology found that not only is the procedure performed too frequently, but that benefits doctors have long attributed to routine episiotomy -- including that it helps women heal faster by reducing tearing and prevents brain damage to the baby by reducing labor time -- appear not to be true.
Research has long suggested that the risks of a routine episiotomy outweigh its claimed benefits. In fact, the American College of Obstetricians and Gynecologists doesn't recommend routine episiotomies. Studies show that unless the baby is in distress, an episiotomy may cause more pain and suffering for the mother than benefit for the baby. Possible problems for the mother include:
Ask when and how often the individual doctors or midwives in your provider's group find it necessary to perform this procedure. Make sure that you're on the same page with them about when and if an episiotomy is necessary.
A caregiver who does few episiotomies will probably recommend several strategies to help you avoid an unnecessary cut:
Once you've had a baby, you're more likely to avoid an episiotomy the next time. If the vaginal area has been stretched once, it should stretch more easily with less tearing for subsequent deliveries, according to Cynthia Hanna, MD, an assistant clinical professor in obstetrics and gynecology at Brown University. And even though the scar tissue from an old episiotomy isn't as elastic as normal tissue, a second-time mother can usually stretch enough to accommodate another baby without tearing badly.
Whether or not you had an episiotomy or stitches from a tear, you'll feel sore or swollen for a few days to weeks after giving birth. Experts say you'll heal faster if you:
Adrienne B. Lieberman, a childbirth educator, is coauthor of Nine Months and a Day (Harvard Common Press).
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.