An episiotomy is a surgical procedure done during a vaginal delivery that consists of cutting the perineum (the tissue between the vaginal opening and anus) to assist the birthing process. Once a common practice, the overall rates for the procedure have fallen drastically within the United States over the past 30 years. One study published in the American Journal of Obstetrics and Gynecology found that in 1979, episiotomies were performed during 60.9% of vaginal deliveries, while in 2004 the rate had dropped to just 24.5%. Another found declining episiotomy rates were due to local peer pressure among health care providers and responses to significant research that came out against the routine use of the surgery. Interestingly, nurse midwives are less likely to use episiotomy to assist during labor than physicians.
Risks/complications from the surgery include:
- tearing of the anus
- blood loss
- sexual dysfunction
Moreover, in the book Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood, author Naomi Wolf asserts:
“What anxious women are not usually advised is that an episiotomy is a serious cut right into the muscle; many women remember it as the most painful and traumatic part of a medicated hospital birth. Nor are women generally informed that, since women’s sexual responsiveness derives largely from the rich network of nerves and blood vessels in just that area, an episiotomy can cause pain during sex, and loss of sexual responsiveness, for up to seven years.”
Alternatives to episiotomy include:
○ Natural tearing: Many experts argue a natural tear is less likely to lead to further medical complications and has a speedier recovery time than episiotomy.
○ Wait it out: Episiotomies can make delivery happen faster, and can be used to expedite the process. If not medically contraindicated, you might avoid the incision by waiting it out.
○ Massage: prepare your perineum ahead of time by massaging it with vegetable oil or personal lubricant.
○ Water birth: studies have indicated that water births are less likely to create tearing or warrant episiotomy.
If you decided against an episiotomy, here are some ways to prepare for your delivery:
● Ask your physician or midwife their thoughts on episiotomy, and how often they perform them. If they’re proponents, you might consider finding another provider.
● Make a plan ahead of time. Tell your doctor, nurse, and/or support person your feelings about the procedure ahead of time. Ask them to do whatever is necessary to avoid the surgical incision before you feel yourself receiving one.
● Get an advocate: get a birthing coach or doula to be your advocate during delivery. If your doctor wants to clock out early by inducing an episiotomy, your advocate can step in and remind the medical staff of your established no-cutting policy.