Episiotomies: What Your Mom Never Knew

Medically Reviewed by Nivin Todd, MD on March 25, 2016
4 min read

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.

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.

Today, doctors rarely offer episiotomy as a choice to women, except if the baby is large or has sudden problems in the birth canal, such as with its heart rate.

“We’d say to the mom, ‘The baby is in distress,’” and explain that that band of tissue is making it harder for the delivery to move along, says OB/GYN Vicki Mendiratta, MD, of the University of Washington School of Medicine in Seattle. “Typically, it’s a decision that you’re making right then and there. It’s not something that you have planned.”

Research shows that an episiotomy doesn’t release “shoulder dystocia,” an emergency situation that happens if a baby’s shoulders get stuck in the birth canal.

“Even when the baby’s shoulders are stuck, it’s more the [mother’s] bony pelvis than [her] soft tissue getting in the way,” says Sonja Kinney, MD, director of general obstetrics and gynecology at the University of Nebraska Medical Center in Omaha.

In some cases, though, doctors use an episiotomy to help move the baby during the birth process.

An episiotomy is often over before you know it. If you’ve had an epidural to block labor pain, you shouldn’t feel anything. Women having natural childbirth may not notice in that moment, either.

“It takes 2 seconds,” Kinney says. “It’s done as the baby’s head is crowning. They’re going to be in a lot of pain [at that moment] anyway.”

After the baby is born, your doctor will stitch up the cut. Expect to feel soreness and swelling for a few days. You can ice the area for the first 24 hours and use pain relievers. Use a squirt bottle with warm water to cleanse the area, and try warm sitz baths to feel more comfortable.

Probably not. Just because you had one episiotomy, you won’t necessarily need it if you have another baby. Your doctor may prefer to have you tear naturally the second time.

Every pregnancy and delivery is different. You might have needed an episiotomy if your first baby was big, but if your second one is smaller, or if the baby is in a different position, it might not be needed, and your natural tear could be smaller than a surgical cut.
If you tear, “you’re going to be a little more likely to tear in the same location,” Phelan says. “That’s going to be the weakest spot.”

She speaks from personal, as well as professional, experience. Phelan’s first child was large and needed forceps, so she got an episiotomy. The second time, she had a smaller baby without forceps, and her doctor didn’t think she would tear much, which turned out to be the case -- no episiotomy needed.

If you had a severe tear or an episiotomy in the past and had problems with fecal incontinence, your doctor may offer a C-section for your next baby. They may be concerned that another serious tear or episiotomy could leave you with long-term problems with bowel control.

There’s no proven way to prevent an episiotomy or tearing. Some women massage the perineum with oil during the last month of pregnancy. It hasn’t been shown to help, but it’s not harmful.

An episiotomy is less likely if you deliver your baby slowly. Many doctors put gentle pressure on the baby’s head to help this happen.

“Toward the end of delivery when starting to crown, give little bitty pushes to accommodate that stretch, rather than this explosive kind of delivery,” Phelan says. Your doctor’s instructions for pushing can help with that.