Episiotomy – How to Avoid One


Everything pregnant mothers should know about episiotomies including the latest research and how to avoid one.

What is an episiotomy?

An episiotomy is a surgical cut from the opening of the vagina toward the direction of rectum. It was a common practice for many years. Some obstetricians continue to feel more comfortable in cutting episiotomies since they may not have been trained in alternative or natural techniques for delivering babies.

However research is now telling us that episiotomies do not help. In some cases, they do more harm than good (see below). Fortunately obstetricians are beginning to follow evidence-based practice guidelines and as a result, episiotomy rates have fallen. Midwives, in general, have been known to cut episiotomies less often than obstetricians.

What can you do to avoid an episiotomy?

1. The first thing you should do is discuss your preference to avoid an episiotomy with your care provider. A good place to start is the Questions to Ask form. It does no good to research alternatives for pushing and positioning as well as do perineal massage if your provider routinely cuts episiotomies. Some mothers may decide to switch providers if the provider’s answers to questions are not in agreement with their plan to avoid an episiotomy.

2. Next write a birth plan. Include ideas for a variety of pushing positions. Request to not give birth lying on your back with your legs in stirrups. Birthing on your back with your legs in stirrups will increase your chances of tearing as well as make it easier for an episiotomy to be performed.

3. Include in your plan a desire to have a slow, controlled birthing of the baby’s head. Request that your provider encourage you to push, if possible, in between contractions during the crowning stage. This will enable your body to slowly stretch over the baby’s head versus coming out too quickly.

4. Ask if one of the members of your birth team (partner/husband, doula, nurse, midwife or obstetrician) use warm compresses during crowning to ease discomfort and assist in stretching. If you have a lot of swelling in your pelvic floor and labia, cool compresses work well to reduce swollen tissue.

5. Starting at 34 weeks of pregnancy, begin doing prenatal perineal massage. This massage has been shown to increase a first time mother’s chance of having an intact perineum.

6. Eat a varied and healthy diet. If you have good prenatal nutrition, your skin will be healthier and stretch better. These include foods rich in Vitamins A, E, K and B complex.

Remember that this is an important decision, not only regarding your birth, but in your long-term health. The research in the last 20 years has been consistently clear. Episiotomies have either caused equivalent outcomes to when no episiotomies were cut, or they have caused more complications such as more postpartum pain, greater blood loss, infection, deeper tears, and playing a role in long-term problems such as bladder control.

For the research-minded parents, here is only a small list of recent research on episiotomies:

  1. Study (Obstet Gyn) showing that anal sphincter tears (deep 4th degree tears) are more likely to occur if mother had an episiotomy.
  2. This research study (Euro J Obstet Gyn Rep Gio) indicates that the rate of episiotomies were reduced in waterbirths.
  3. Researchers (J Repro Med,) found that the episiotomy rate was decreased when physicians were taught about the latest evidence and also had to document a reason for performing an episiotomy.
  4. This study (Green Journal) showed that a significant increase in anal sphincter tears occured when mothers had both an instrumental birth (vacuum or forceps) and an episiotomy.
  5. Interesting study (Jnl Repro Med) that indicated episiotomy rates were higher in private practice physicians versus staff residents.

Additional research can be found by going to the medical research search engines at Pub Med or the Cochrane Library

DId you talk with your obstetrician or midwife about episiotomies? What did you learn about their philosophy or routines? Share with us.

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