Avoiding an Unnecessary Episiotomy

Avoiding the Big E (Episiotomy)

Still a routine procedure in many Irish hospitals learn how you can reduce your chances of getting an episiotomy.

Avoiding the Big E (Episiotomy)
Tracy Donegan CD CBHE

Of all the squeamish discussions about birth experiences probably nothing makes you cringe and cross you legs quicker than when talk about labour turns to the big E…..no not the epidural but the episiotomy.

More and more women in Ireland are questioning a once routine procedure that involves enlarging the opening of the birth canal as the baby’s head crowns.

Many Irish hospitals continue this outdated procedure despite significant studies that show routine episiotomies cause more harm than good.

Learn how you can avoid an unnecessary episiotomy.

Imagine the following: if you hold a piece of cloth at two corners and attempt to tear it by pulling at the two ends it’s very difficult to rip. However, if you make a small snip in the center, and pull the corners the cloth rips easily with no resistance.

Episiotomies are ‘said’ to have the following benefits.

• Speed up the birth
• Prevent tearing
• Protects against incontinence
• Protects against pelvic floor relaxation
• Heals easier than tears
The following have been reported as side effects of the episiotomy:
• Infection
• Increased Pain
• Increase in 3rd and 4th degree vaginal lacerations (euphemistically called extensions)
• Longer healing times
• Increased discomfort when intercourse is resumed


Following are some of the myths surrounding episiotomies

Myth: A nice clean cut is better than a jagged tear.
Reality: "Like any surgical procedure, episiotomy carries a number of risks: excessive blood loss, haematoma formation, and infection. . . . There is no evidence . . . that routine episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents fetal trauma or reduces the risk of urinary stress incontinence." Sleep, Roberts, and Chalmers 1989
Routine episiotomy (as opposed to episiotomy for an emergency situation such as fetal distress) is a typical example of an obstetrical procedure that still exists despite a total lack of evidence for it and a considerable body of evidence against it.

Myth: Episiotomies help prevent brain damage as the baby’s head ‘pounds’ against the tissues.

Perhaps the most absurd rationale of all is brain damage from the fetal head's "pounding on the perineum." A woman's perineum is soft, elastic tissue, not concrete. No one has ever shown that an episiotomy protects fetal neurologic well-being, not even in the tiniest, most vulnerable preterm infants, let alone a healthy, term newborn (Lobb, Duthie, and Cooke 1986 and 1990.

Myth: Episiotomies help protect the mother’s pelvic floor and reduces her chances of incontinence.

What are pelvic floor problems?
Many women experience pelvic floor dysfunction around the time of birth and/or later in life. Pelvic floor problems include leaking urine (urinary incontinence), leaking gas or — more rarely — feces (bowel incontinence), sexual dissatisfaction, and a sagging of the inner organs (uterine and other pelvic organ prolapse). It is important for every woman to understand what she can do to keep her pelvic floor strong and protect it from injury.

Separating fact from fiction: what causes pelvic floor dysfunction?

These days, there is a lot of conflicting and confusing information about the cause of pelvic floor problems. Vaginal birth has been blamed, and some suggest that enlarging the opening of the vagina by cutting it at the time of birth (episiotomy) or even having a surgical birth when there is no medical complication (elective c-section) will prevent weakened pelvic floor muscles and injury. Unfortunately, there is a lot of false, unproven, and incomplete information on this topic.
Gordon H and Logue M. Perineal muscle function after childbirth. Lancet 1985;2:123-125

Myth: Some women need episiotomies because they are not as ‘stretchy’ as others.
Another absurd example of non researched based practice. There is no medical evidence to support this.

Episiotomies are rarely necessary; you can lessen your chances of having this surgical incision. Some preventative measures that may help are:
• Chose a Doctor who doesn’t do routine episiotomies. (Ask your Doctor how often he finds it necessary to do episiotomies)
• Good nutrition (healthy skin stretches more easily)
• Do your Kegels (exercise for your pelvic floor muscles)
• Prenatal perineal massage
• Slow controlled pushing instead of directed pushing by Doctors and midwives. (Only push when you feel the urge).
• Birth off the bed – not on your back.


Remember, as with any medical procedure, there is always a time and a place where it is a valid option.
Being knowledgeable about your body and any proposed procedures during labour will take you a long way to having a more satisfying birth.
Hartmann K, Viswanathan M, Palmieri R, Gertlehner G, Thorp J, Lohr KN. Outcomes of routine episiotomy: a systematic review.JAMA 2005;293:2141-8.