Tough choice, huh? Our labor nurse weighs in on tearing during childbirth or choosing an episiotomy, and explains why it's often not your decision to make in the delivery room anyway.

By Jeanne Faulkner
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One of the most popular items on a birth plan: No episiotomy under any circumstances. An episiotomy is an incision in the perineum (the skin, tissue, and muscle between your vagina and rectum) made in order to enlarge the vaginal opening and prevent spontaneous tearing.

And mothers-to-be may have good reason behind their demands: A May 2019 analysis from USA Today found that episiotomies are happening more often than necessary, and that the mothers suffer long-term health consequences from them.

According to the report, national guidelines made in 2006 state that only emergency situations, like a baby with shoulders too large to fit through the vagina, require an episiotomy. Predictably, then, episiotomies should occur in less than 5% of vaginal births.

However, USA Today spent four years analyzing nearly 240,000 new mothers, and found episiotomies occurred at rates of 20% or higher in dozens of hospitals. “Those with the highest rates of episiotomies included major medical centers in big cities, mid-sized hospitals in metropolitan suburbs and small facilities in rural communities,” says the article.

USA Today further reports that unnecessary episiotomies lead to severe health consequences, including deep lacerations into the anal sphincter, infections, and psychological consequences. Some women also need surgery to repair their body after episiotomies.

What causes the high number of episiotomies? According to USA Today, doctors claim outdated medical practices, as well as a desire for speedy births, is the culprit.

Episiotomy vs. Tearing

Both episiotomies and tearing are graded as first through fourth degree. First degree is a tearing of the skin only. Second degree involves the underlying perineal/vaginal tissue. Both are pretty easy to stitch up and you'll be good as new within a month or so.

Third degree involves the rectal sphincter and fourth degree has to deal with the rectal mucosal tissue. Third and fourth degree tears/episiotomies are bad news and require a lot of skill and needlework to repair.

If you're delivering with a midwife or family practice physician, they're very likely to call in an obstetrician to do that repair for them. But they can be repaired and heal very, very well. Yes, you'll be able to poop and have sex just like before kids. Still, nobody wants a third or fourth degree laceration. That's part of the reason forceps are less popular these days and C-sections are more common.

Some studies say long-term effects of a really bad tear/episiotomy can result in incontinence down the road. There are an equal number of studies that say these facts aren't true—incontinence is caused by aging not damage.

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