Let's Talk About Episiotomies and Tears

An episiotomy is something women may get during a vaginal delivery. It is when the doctor cuts along the vaginal opening to take pressure off the tissues and assist with the baby’s head passing through. The cut can be done straight down or at a diagonal.

I realized over the past couple of weeks that many of my clients don’t know much about episiotomies and they wish they had known more about them. I think knowing in advance about medical interventions is helpful because it gives you an increased sense of comfort over what is happening to your body versus something being done with no knowledge. The comfort comes from knowing the risks/benefits of a procedure, so that even if the procedure is necessary you understand why.

So after making this realization I thought it would be helpful to talk about this for women who are pregnant or women who have given birth and are curious about what’s happened.

There are a number of reasons an episiotomy may be performed.

1. The doctor sees a high risk for tearing upwards through the urethra

2. The doctor sees a high risk for tearing downwards into the anus

3. The baby is under distress and the tissues around the vagina has not stretched enough delaying the exit of the baby

4. Multiple births occurring at the same time and doctor needs to speed up the birth

5. Routine practice by the doctor

I believe knowing the possible reasons in advance allows for a more open discussion with your healthcare provider about the intervention and allows you to advocate under what circumstances you want an intervention performed. There are lots of women that want the birth to be as natural as possible with no medical interventions, so talking about episiotomies in advance can reduce surprises later if one becomes necessary.

So what about tearing naturally? Is that better than having an episiotomy? There is no right or wrong answer to this question, it comes down to consent I believe. The ability to choose based on an open discussion in advance, so that no matter the outcome, you feel you made the choice.

So episiotomies are controlled cuts, whereas natural tearing will happen on its own till the pressure is released around the vaginal opening allowing baby’s head to pass. However it is important to note that having an episiotomy does not preclude you from tearing past the cut or tearing in another area. 

In some cases the episiotomy spares more severe tearing.

Did you know there are different grades of tears?

Grade 1 is tearing of the skin and fascia

Grade 2 is tearing past the skin, fascia and mucosa layer into muscle but not to the anal sphincter

Grade 3 is tearing past the skin, fascia, mucosa into the anal sphincter

Grade 4 is tearing past the skin, fascia, mucosa, muscle past the anal sphincter and into the rectal mucosa lining. (1)

1  https://en.wikipedia.org/wiki/Perineal_tear

I hope this helps you understand more and gives you a context under which you can ask more questions.

The Pelvic Health Lady