In plain words
An episiotomy is a cut a provider makes in the during birth. The cut widens the opening so the baby can come out. It was once done almost routinely. Today most providers use it only when needed, such as when the baby needs to come out quickly or when a tear would be severe. Many mothers who avoid an episiotomy still have some tearing, which heals on its own in most cases. Ask your provider how often they use episiotomy and what they would do in your case. Warm compresses, slow pushing, and perineal massage before birth are options some mothers try to lower the chance of a cut or a tear. Healing takes a few weeks, and stitches are common.
The deeper version
Episiotomy is a surgical incision of the perineum, most often mediolateral or midline. The Cochrane review by Carroli and Mignini (2009) found that restrictive episiotomy use is associated with less posterior perineal trauma, less suturing, and fewer healing complications, with more anterior perineal trauma and no clear difference in severe trauma. Routine episiotomy rates fell across high-income countries after the 1990s, while rates remain high in some regions. Antenatal perineal massage in women reduces the need for episiotomy in one Cochrane review (Beckmann and Garrett, 2006). Warm compresses and hands-on guidance of the fetal head in the are described as lowering severe trauma in the literature. The ACOG Practice Bulletin on (No. 198, 2018) states that episiotomy is indicated for specific obstetric situations and not for routine use.
Where it comes up
- Perineal massage, tearing, and episiotomyGetting Ready for Birth
- Healing a tear or stitchesPostpartum: Your Body
- OB or midwife: choosing who catches your babyGetting Ready for Birth
- Pushing and positions for birthGetting Ready for Birth
What mothers here say about episiotomy
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Sources
- Carroli G, Mignini L — Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, 2009
- American College of Obstetricians and Gynecologists — Practice Bulletin 198: Prevention and management of obstetric lacerations at vaginal delivery, 2018