Chances are, you probably know enough about episiotomies — where an incision is made in the perineum to enlarge the vaginal opening and make room for baby's grand entrance — to know that you'd rather not have one. But you may be wondering whether you'll heal faster after having an episiotomy or a natural tear during labor.
Episiotomy vs. natural tearing
When it comes to recovery, moms usually do better with a natural tear than with an episiotomy. Research shows less pain, fewer complications like infection or incontinence, and quicker healing overall. While natural tears can still come with some discomfort, recovery tends to be easier than healing from a cut.
What's more, episiotomies are more likely than spontaneous tears to result in more severe third- or fourth-degree perineal tears, which can extend all the way to the rectum. These types of tears take longer to heal and can sometimes cause ongoing issues, like fecal incontinence.
Until recently, midwives and doctors often performed episiotomies as a routine step during vaginal birth. The thought was that a clean cut would be easier to heal than a natural tear and might help prevent issues like incontinence later on. Some providers also worried that, without an episiotomy, a baby could face birth trauma from pushing too long against the perineum.
But research has since shown otherwise: moms and babies usually do just as well — and often even better — when birth is allowed to progress naturally without an episiotomy. These days, episiotomies are much less common.
After the American College of Obstetricians and Gynecologists (ACOG) recommended against their routine use, the episiotomy rate dropped by more from 33% of vaginal births in 2000 to about 12% in 2012. More recently, that number has fallen even further to just 3.4%, according to the Leapfrog Group, a nonprofit patient safety organization.
"When I tore naturally … healing was 10x better than being cut," says What to Expect Community mom Fatekap.
When should an episiotomy be performed?
That said, there are still situations where an episiotomy can be the safest choice — like when baby's head is especially large, when forceps or vacuum delivery is needed, or when shoulder dystocia (when a baby's shoulder gets stuck) occurs.
"My son was stuck so had to have an episiotomy in the end," says What to Expect Community mom DottieMama. "No one wants one but in the end you do whatever you have to for the baby to come out safely."
Other moms share similar stories. When her baby's heart rate started spiking, says What to Expect Community mom Sarahberry716, "They had to use the vacuum and give me an episiotomy. I was terrified of both and so upset that it came to that, but if it hadn't worked, I would have had an emergency C-section. So I am grateful for the episiotomy, it helped my daughter be born safely."
Want more information about what to expect during every stage of labor and delivery, as well as what to put into your birth plan? Find it in the What to Expect app, where you can track your symptoms, get expert advice, and connect with other parents.
If you do wind up with an episiotomy, your provider can tell you which activities to avoid and treatments to help ease any discomfort, like cold packs and warm sitz baths.
It's a good idea to discuss the possibility of an episiotomy with your doctor or midwife well before your due date. Chances are, they'll agree that the procedure shouldn't be performed without a very good reason.
Just keep in mind that the final decision should be made by your health care provider at the time of delivery, when that little head is crowning.
Happy delivery!
Heidi
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