Q. Do I have to have an episiotomy?
A. The majority of women don't have an episiotomy, which is a small cut made into the perineum (the area between the vagina and the rectum) to widen the vaginal opening. Episiotomies are performed to make delivery easier or to prevent tearing of the vaginal tissue.
Although episiotomies were performed routinely for nearly a century, they occur less frequently now. Between 1983 and 2000, the episiotomy rate fell from about 70 percent of all vaginal births to about 20 percent, according to the American College of Obstetricians and Gynecologists.
Episiotomy rates can vary widely, however. A 2003 study found that women who deliver their babies attended by physicians in private practice are seven times more likely to undergo an episiotomy than women whose babies are delivered by OB/GYN residents or hospital faculty physicians. The researchers suggested that the higher rates among private physicians may reflect the period in which they trained.
Years ago episiotomies were believed to prevent tearing of the vagina and damage to the pelvic floor. However, recent studies have shown that vaginal tears cause less pain and bleeding than episiotomies and that pelvic floor damage is more likely to occur with an episiotomy than with a tear.
Feel free to inquire about your doctor's and your hospital's episiotomy rates. If you don't want to have an episiotomy--and who does?--discuss your feelings with your doctor.
Preventive measures. Studies show that perineal massage can reduce the need for an episiotomy. Massage can help make the perineum more flexible and stretchy, so when the baby comes out, the perineum is more likely to stretch than tear. To do perineal massage, sit in a warm bath and gently massage the area around the opening of the vagina for about 10 minutes a day, beginning around week 34. This won't guarantee you an episiotomy-free or tear-free delivery, but it may help.
When an episiotomy is required. Episiotomies may be necessary in some situations: if your baby's heart rate drops and delivery is expedited by cutting the perineum, if she is being delivered by forceps or vacuum suction, or if her shoulders are too wide to fit through the birth canal.
The procedure. If you have an episiotomy, your doctor will give you a shot of local anesthetic to numb the area before cutting, unless the area is already numb from your epidural. The cuts range from superficial to deep: An episiotomy is said to be first-degree if only the skin is cut; second-degree if the skin and underlying tissue are cut; third-degree if skin, underlying tissue, and the muscle around the anus are cut; and fourth-degree if the cut goes through the rectal mucosa as well as the other three layers. Usually only a second-degree cut is made, but the baby's head extends the cut to tear the muscle or rectum. After your baby is born, your doctor will stitch the episiotomy and other tears with dissolvable sutures.
Originally published in You & Your Baby: Pregnancy.
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