Once a routine part of childbirth, an episiotomy is now recommended in certain cases only.
First and foremost: what is an episiotomy exactly?
An episiotomy is an incision made in the perineum - the tissue between the vaginal opening and the anus - during childbirth.
And why would you want anyone to cut your vagina during childbirth??
For years an episiotomy was thought to help prevent more extensive vaginal tears during childbirth and heal better than a natural tear. The procedure was also (incorrectly) thought to help preserve the muscular and connective tissue support of the pelvic floor.
Thankfully over the years research suggests that routine episiotomies don’t prevent these problems after all. The recovery is very uncomfortable since it requires a deeper layer of tissue to be stitched. And it’s often said that the incision is more severe than a natural tear would have been. One midwife helped me understand this by explaining trying to tear or rip a piece of fabric with my bare hands. She said it’s very challenging and takes a lot of effort. But, if you just snip a little bit of the fabric with scissors and then pull it’s a breeze. The incision in your pelvic floor tissue reacts very similarly. Once you cut the tissue it gives much more leeway to cause a deeper longer tear from the pressure of your baby making its way out. OUCH. NO THANK YOU.
Just like any medical intervention during birth, I’d prefer something like an episiotomy to be done only when it is really necessary. Often during emergency cases your healthcare provider will need the extra space at the vaginal opening to allow for an easier instrumental birth, i.e. the use of forceps or vacuum extraction. A few other reasons I’ve heard of episiotomies being absolutely necessary are if:
Your baby is in an abnormal position and needs more assistance to make it out
Your baby is very large (fetal macrosomia)
Your baby needs to be delivered quickly