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    Episiotomies: What Your Mom Never Knew

    WebMD Feature
    Reviewed by Nivin Todd, MD

    Will you get an episiotomy when you have your baby, just like generations before? The chances are good that you won’t. But just in case, you’ll want to know what’s involved and when it might have to happen -- even if it was not in your plans.

    An episiotomy is a surgical cut that the doctor makes between the vagina and anus (doctors call this area the perineum) as you give birth. The goal is to extend the vaginal opening so there’s more room.

    Nearly all birth moms used to get it. But today, it’s not routine anymore -- but it’s not a thing of the past, either.

    Then and Now

    Episiotomies were common decades ago, and for what seemed like good reasons.

    Back then, many doctors used tools called forceps to help deliver babies. So they needed extra room to maneuver. Experts also thought that an episiotomy would make long-term problems after childbirth, like incontinence and pain during sex, less likely. And they thought that the cut was better than natural tearing.

    That turns out not to be the case.

    Since the 1990s, researchers have re-evaluated studies and found that episiotomies “probably weren’t applying the benefits they were supposed to have,” says William Goodnight, MD, associate professor of maternal-fetal medicine at the University of North Carolina School of Medicine in Chapel Hill.

    “Although they are easier to repair than a tear, there was a greater risk that the cut would extend and you would find yourself with a greater injury,” says OB/GYN professor Sharon Phelan, MD, of the University of New Mexico in Albuquerque.

    Some studies show that up to 85% of women tear -- at least a bit -- naturally during childbirth. Tears (and episiotomies) can range from mild to severe (or, as doctors say, from first to fourth degree). The most severe cases can harm the anal muscles and anal lining, which can cause problems controlling bowel movements.

    With an episiotomy, there may be a chance that the cut may extend farther than a natural tear would have gone, which could damage the anal muscles.

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