Episiotomy vs tearing naturally

Date: 2010.07.24 | Category: Birth | Tags: cutting vs tearing in childbirthepisiotomyepisiotomy reasonsnatural tear during birthroutine episiotomy

Women giving birth to their babies in American hospitals have about a one in three opportunity that they will end up with an episiotomy an incision in the flesh between the vagina and rectum. One reader asked me to write about the pros and cons of an episiotomy like opposed to natural tearing. I will go one step further and beg in what circumstances episiotomies are justified at all.

Routine episiotomies are episiotomies that are cut as a thing of course regardless of a laboring woman s individual circumstances. Cutting a routine epsiotomy is done by doctors who trust that it is easier to stitch up a cut than a natural tear who believe that an episiotomy will speed up birth and who believe that women s bodies are somehow broken . Routine episiotomies in my opinion are never justified.

One of the most evident benefits of allowing a laboring mother to tear naturally rather cutting an episiotomy is that not every woman tears at all. As soon as an episiotomy is cut perineal damage becomes inevitable. Without cutting there is every chance that a woman will not tear at all or so minimally that no stitches will be required (the so-called skid mark ). Furthermore giving birth in the lithotomy position smooth on the back greatly increases the chances of tearing as the woman is effectively pushing against gravity. Squatting sitting upright on a birthing stool or in a birthing pool and other more natural birthing positions help decrease the possibility of tearing.

With regard to the healing process opinions are divided. Some women who have had both episiotomies and natural tears say that they healed more easily behind being cut whereas others report natural tears took less time to heal. It is safe to presume that this has a lot to do with the size of the episiotomy and the method with which it was cut or the severity of the natural tear and its direction.

It is interesting to note that episiotomies do not necessarily prevent natural tears which is one of the more frequently cited reasons for cutting them. Further tears are not even often along the episiotomy line meaning that an episiotomy leaves a woman open to the possibility of having a cut as well as a tear often in totally different locations.

Are there any justified reasons for cutting an episiotomy then? Under certain circumstances episiotomies can indeed benefit mother and child except such situations are rare. Circumstances that arguably warrant an episiotomy include:

True shoulder dystocia in which a midwife needs to achieve in to help the baby be born. Though shoulder dystocia is caused by a bone obstruction and not by tissue an episiotomy can sometimes give birth attendants the space they need to take out the maneuvers that solve shoulder dystocia.

If fetal sorrow means that the baby needs to be born so urgently that every minute counts.

To get access in the case of rare vaccum or foreceps deliveries.

When scar tissue in the mothers birth canal prevent the baby from being delivered. Such scar tissue can be caused by a variety of issues one of which can be a prior episiotomy.

According to Ina May Gaskin a breech baby who is presenting testicles first (yes apparently it happens!) warrants an episiotomy. Im not sure why.

Thanks for this! Now I want to understand why we deliver the way we do in hospitals if its unnatural and fighting against gravity? That is silly.

writenow

10/07/25 11:26

Because it is easier for medical personnel and it has crept into normal practice? If you want to try something else perhaps seem into a birth center for your next (ahem!) baby?

Great article! Thank you!

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