ACOG advises against routine episiotomies.
An episiotomy is a surgical cut of the skin and muscles between the vagina and the rectum.
Many healthcare providers used to perform routine episiotomies on nearly all patients immediately prior to delivery. Their intent was to avoid damage to the rectum, as well as to expedite delivery. However, over time, research showed that commonplace episiotomies were actually associated with an increase in perineal trauma (damage to the area between the vagina and the rectum). Consequently, the rate of episiotomies plummeted from nearly 60 percent in the 1970s to 25 percent in 2004. There likely remains an opportunity to decrease this number further.
Today the American Congress of Obstetricians and Gynecologists (ACOG) recommends against the use of routine episiotomies, preferring to allow the baby to make any tears necessary to come through the birth canal.
There may be some situations in which your provider wants to perform an episiotomy for your and your baby’s health and safety. The most common reason for an episiotomy in such cases is fetal distress, meaning a low heart rate in your baby. An episiotomy allows the baby to be delivered faster. Similarly, an episiotomy may be used during a vacuum-assisted or forceps delivery — again, in order to deliver the baby sooner. Lastly, in the rare circumstance that a baby’s shoulder is stuck, an episiotomy may facilitate delivery.
Your provider will likely discuss an episiotomy with you at the delivery — as time allows — if he or she decides that the procedure will be helpful in the birth. You may receive an numbing-medicine injection at the site, if you do not already have pain medication, such as an epidural.
Following an episiotomy, you will receive stitches to repair the muscles and the skin. Stitches are quite common, even among women who do not have episiotomies, and the tears are repaired in the same way. Most women find that their discomfort is gone within a few weeks with the assistance of ice packs and topical creams. Though rare, complications from an episiotomy can include an extension into the rectum, excess bleeding and infection — all of which may prolong your recovery time.
You may want to ask your provider at your next visit about the use of episiotomies in the practice, so you can discuss the best plan of care for your delivery. You may also find it helpful to write out a birth plan to let your healthcare team know your wishes.
Mimi Wachendorf Fradinho, MD, is an ob/gyn with Harvard Vanguard Medical Associates, practicing at Beth Israel Deaconess Medical Center, Boston.