Many new mamas are left overwhelmed and unsure about all of their options regarding childbirth. The decisions sometimes seem incomprehensible, and sometimes it’s not even clear why you should have to decide. Delayed cord clamping? Natural or epidural? Episiotomy vs tearing?
Wait a second…episiotomy? Tearing?? NONE of us want to have to spend time thinking about the cutting or tearing of our vagina. I mean, it’s HORRIFYING to think about.
Here’s a perk: Experts no longer recommend the routine episiotomy – so you can pretty much check this decision off of your list. However, there are still some situations where an episiotomy is the right choice.
Because of this, I wanted to go over getting an episiotomy vs tearing so that you can make a well-informed choice.
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Simply put, an episiotomy is a small surgical incision made in your perineum (which is that ridge of tissue between your vaginal opening and anus) during childbirth. We’ll discuss the “why” in a little bit. Let’s take a minute to examine the “what”.
There were many assumed benefits of this procedure, which we’ll discuss in a minute. As you can probably imagine, something that we can anticipate and mitigate seems like a great idea, but providers of today have changed course on this.
Doctors used to believe that episiotomies were better than natural tearing for a few different reasons:
There is a myriad of other reasons most doctors used to perform routine episiotomies, but NONE of these reasons could be scientifically backed up as being better than allowing for natural tearing.
When it comes to your lady parts, the data has shown one thing time and time again. Naturally tearing is USUALLY the better option – unless there’s a medical emergency that necessitates episiotomy.
Why, you ask? Well, it’s been proven that routine episiotomy typically increases the risk of severe tears, as well as long term damage to the pelvic floor, vagina, perineum, and anal sphincter.
There is no material benefit to mama or baby for a surgical incision in the hinder parts. MOST of the time. With that said, they do have a time and place.
To really get a good understanding of the exceptions, it’s worth considering the facts.
The episiotomy type clarifies how and where the cut in the perineum is made, which helps us understand why they are sometimes used.
There are many different types of episiotomies, but two are performed most often – a median and a mediolateral episiotomy.
Median episiotomies used to be more common because medical professionals believed that mediolateral episiotomies were more painful for women to recover from (among other things).
More recent research has shown us that there isn’t a lot of difference in postpartum pain, but median incisions are much more likely to result in 3rd and 4th degree tears (the WORST kind of tears – UP YOUR BUTT).
How it works:
This is considered to be the safer, more comfortable, and more commonly form of episiotomy. If your provider determines an episiotomy is necessary, this is probably what you’re going to be looking at.
Here’s how this one works:
We classify episiotomies by the severity or extent of the surgical cut by rating them on a 1-4 scale. This same classification exists with natural tears.
The worse the cut (or tear), the more likely it is that you may see complications.
Both a third and fourth degree tear are bad news (surprise! Pretty much a given when a tear extends to your BUTT HOLE) and sometimes require anesthesia to repair.
Recovery from a severe tear usually takes longer and is more complicated. Because – yeah, you tore your bum.
We now know that there’s a higher risk of maternal or neonatal injury when a routine episiotomy is done instead of allowing for natural tearing to occur.
ACOG (American College of Obstetricians and Gynecologists) has recommended AGAINST routine episiotomy since 2006. We’ve see a decline in practitioners who use episiotomy vs natural tearing, which means we see fewer injuries too.
Nature, 1; Medical intervention, 0.
Now – there remain some old-school providers who perform episiotomies routinely. I don’t see it a lot, but I do think for some it is more comfortable to keep doing what they’ve always done.
In fact, some studies have shown a direct correlation between episiotomy rates and the years a practitioner has been practicing…meaning the longer they’ve practiced, the more likely it is they’re still doing episiotomies (but to make it clear – most DO NOT).
It’s not the norm for medical professionals to go against the general recommendation -but that doesn’t mean it never happens.
Ask your medical provider for their episiotomy rate, and don’t be afraid to voice your concerns and switch providers if your current medical professional is resistant to the idea of avoiding it where possible.
If you’re really struggling during that pushing stage of labor, baby’s head is just too big, or your doc is concerned about you or baby’s safety- an episiotomy may be medically necessary.
It goes without saying that this could end with a pretty nasty cut to your booty.
This is why it’s SO important to make sure you have trust established with your provider. You should never feel pressured into something you don’t want to do – and a good relationship with your provider will help with that. Confirm that your doctor will gain your consent before performing an episiotomy, if possible (which they should do anyway).
I think the most important thing here is to avoid discounting the possibility of an episiotomy. On the other hand, if your medical professional proudly says they perform them routinely for #allthebirths, it may be worth challenging that or switching doctors.
Start the conversation with them. The worst time to find out that your medical professional is slice-happy is when you are three clicks in on your epidural and your partner has already passed out.
This is where you seriously have to look at mother nature and say, “Come on lady, you’re a MOTHER! What the actual heck.”
Unfortunately, tearing during childbirth is relatively common. According to ACOG (American College of Obstetricians and Gynecologists), SOME kind of tearing will occur in 53-79% of women having a vaginal delivery. The bright side of this is more severe tears only happen in around 3% of births.
Hey – at least we don’t carry our babies for up to 18 months, like whales do!
The actual tearing usually occurs when baby’s head or shoulders are trying to get through the vaginal opening. Our vaginal openings are pretty elastic, so many of us can get away with none or minimal tearing (second degree being most common).
If your baby’s head can’t make it through your vaginal opening without tearing, you can definitely blame the father. Particularly if they have a big head too. ?
Related Reading: Pain Meds During Labor (Other Than an Epidural)
While there’s no way to prevent tearing during delivery completely (sorry mama!), there are things you can do to minimize how severe the tear will be.
Here’s more (super good) info on preventing tearing during delivery!
While we know that your birthing position can impact how badly you tear, the research is inconclusive regarding the BEST position is to avoid tearing.
I think the best advice I can give you is to do what’s comfortable for you. There’s no surefire way to avoid tearing, so you may as well let yourself be as relaxed as you can.
The best study I’ve found regarding birthing positions and severe tearing is a research article that examined seven different birthing position studies. Like any good medical read, it can get a bit mind-numbing. As an expert in the field, I’ve taken the liberty of summarizing the important bits below.
Unfortunately, no. The study I cited shows that women who have a water birth are MORE LIKELY to tear than women experiencing a land birth. With that said – many women report a water birth to be less painful, so it’s still worth considering – the reality is that these women might have torn regardless the method they chose.
There is unfortunately no way to know, which is why data is always going to be spotty.
By the way – if you’re looking for some clear instruction on what to expect during labor and delivery, check out my birthing course Birth It Up!
The best thing you can do to make sure that you don’t end up with an unauthorized episiotomy is to have a discussion with your healthcare provider BEFORE you go into labor (and make sure you trust your provider). Add it to a birth plan, mention it to your nurses, drill it into your partner’s skull.
All that said, please remember to stay flexible in case an emergency arises. If your medical professional insists, don’t let any of this information deter you. You’ve chosen this professional for a reason, so have faith that they have your best interests and those of your baby at heart.
Related Reading: Midwives’ Brew
We know that an episiotomy is no one’s first choice. If you end up needing one anyway, here are some of the common complications I’ve seen with episiotomies:
These are some pretty nasty complications that can end up being something you will deal with for a long time. Keep in mind that some of these complications can happen with natural tearing, which I’ll outline below.
The risks associated with a natural tear are similar to the risks associated with an episiotomy, but you’re more likely to sustain LESS damage from naturally tearing. Here are some of the risks associated with natural tears during childbirth.
Related Reading: How to Induce Labor Naturally
If you did not tear with your first childbirth, you’re a lot less likely to tear with your second child. Unfortunately, if you experienced a 3rd or 4th degree tear with your first child, there’s a higher chance that you’ll experience a severe tear with your next childbirth.
As a new mama you have a LOT of hard decisions to make, but the choice of episiotomy vs tearing doesn’t need to be one of them.
Make sure there’s significant trust between you and your doctor, and don’t be afraid of having a conversation with them. It is my sincerest hope that you feel more empowered to do the right thing for you and your little bundle of joy.
Good luck, mama!
Drop a comment below and let me know if you have any further questions regarding an episiotomy vs natural tearing. I’m happy to help!
Related: Reading What Happens During Delivery?
Related Reading: Scheduled C-Section: What to Expect