The pros and cons of episiotomies

No matter how thoughtfully planned out your birth plan may be, there are bound to be a few surprises once you hit home base, aka, the delivery room. If you’re giving birth for the first time, your first shock (and horror) may be the sight of a doctor’s toolkit by your bed filled with scalpels and scissors.

Yes, scissors.

It isn’t uncommon for women to report that the experience of childbirth left them feeling as if they had little control over their bodies. Some may feel anger or resentment over never being asked by their doctor whether they wanted to tear naturally or have an episiotomy, which is a surgical incision made to the muscle between the vagina and the anus that helps deliver a baby. The best thing we can do as women is arm ourselves with facts about the pros and cons of each — and learn why these decisions are sometimes made for us.

More: The Mamafesto: Mother who had forced episiotomy fights back in court

The episiotomy used to be the most common surgical procedure performed on women, says Dr. Sherry Ross, OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. The good news, especially if you’re frightened of this procedure, is that the episiotomy is on the decline and less commonly recommended as the first choice for helping deliver a baby vaginally. “It used to be this procedure made enough room for the baby’s head to be delivered with the least amount of damage to the vagina,” Ross says. “Now it’s thought to be more damaging than helpful.”

The pros to getting an episiotomy include preventing tearing into the rectum or urethra and reducing the amount of time you have to push during labor. On the other hand, there are several complications involved with the procedure that could include infection, longer healing time, increased extension of vagina affected, bleeding, pain at the site of the episiotomy and future pain during sexual intercourse.

Women who are most likely to tear during childbirth include those giving birth for the first time or who have a larger-than-normal-size baby, vacuum- or forceps-assisted delivery, vaginal swelling due to prolonged pushing, the need to expedite delivery because of fetal distress and/or a baby being born face-up.

You may resent not being asked ahead of time by your doctor if you want an episiotomy, but doctors say the decision to do an elective episiotomy is not known until the moment right before birth.

“Most doctors do not ask because we do not do routine episiotomies,” says Dr. Sarah Yamaguchi, OB-GYN at Good Samaritan Hospital in Los Angeles. “We only do them when they are medically indicated, such as when the baby’s heartbeat is very low and the baby needs to come out immediately and we cannot wait for the natural process to occur. Also, in some cases, it does seem like an episiotomy will provide an easier recovery than natural tearing, so it is done. The decision for an episiotomy is not made hours or days ahead of time. It is made at the very last second when the physician feels it would be the right decision for the patient.”

Yamaguchi encourages women to ask their doctors questions about episiotomies if they are concerned and reminds us that it’s crucial we trust our OB-GYN. With that said, childbirth is one time in our lives when we may not be able to control the wheel.

“A lot of women want to tightly control their labor and their delivery, but that is impossible,” Yamaguchi says. “There is still a lot of art to obstetrics, and to restrict your physician from what they think is best can end up causing more harm than good.”

More: When are forceps used during the delivery of your baby, and what are the common concerns?

Bottom line: As long as you trust your doctor, you are likely in very good hands — and any concerns you have about birth and tearing should be brought up long before your water breaks.

“The important thing is to have a conversation with your doctor prior to the last 10 seconds of your delivery,” Yamaguchi says.

“I always reassure my patients the decision of cutting the vagina or letting the tissue tear naturally is determined at the time of the delivery,” says Ross. “Some factors include how long the woman has been pushing, how large is the baby’s head, how swollen is the vagina and is there any reason to deliver the baby quickly due to fetal distress? As long as you reassure a pregnant woman you have their best interest and the interest of the baby first and foremost, the conversation ends comfortably.”