What you should know about episiotomies

While they're no longer a routine labour intervention, episiotomies are still a possibility in the delivery room.

Photo: Cordmamas via Instagram

Toronto mom Serenity Kovarik wanted to avoid having an episiotomy—a surgical cut in the perineum (the area between the vagina and the anus) used to widen the vaginal opening during delivery—when her second baby, Tase, was born. (Her first was delivered by emergency C-section.) But when the head emerged and doctors saw the umbilical cord wrapped tightly around her baby’s neck, they didn’t even stop to tell Kovarik what they were about to do. “I heard the doctor say to the resident, ‘Get the scissors. We’re going to have to do an episiotomy.’” After the cut, Tase—not breathing and with the cord around his neck four times—was out in a matter of seconds and crying healthily minutes later.

There are few things that will make a woman cross her legs faster than the thought of a scalpel coming near her lady parts. But for much of the 20th century, episiotomies were a routine part of giving birth in a hospital. Particularly for first-time moms, doctors believed episiotomies helped avoid severe tears and damage to pelvic-floor muscles, prevented incontinence, caused less immediate and long-term pain and promoted faster healing. Decades and many research studies later, we now know episiotomies actually put women at a higher risk for significant tears and don’t do anything to shorten recovery time or reduce pain.

These findings have resulted in a shift from routine use of the procedure to a “restrictive” one in Canada. “Now the standard is not to do the episiotomy unless you have to expedite the delivery,” explains Rose Kung, an OB/GYN at Sunnybrook Health Sciences Centre in Toronto, adding that it’s also sometimes done to avoid tearing into the rectum, if the distance between the vagina and the anus is minimal. “We don’t do it because we want to do it. It’s only done under specific circumstances.”

Doctors will also sometimes offer an episiotomy to accelerate a long labour if the mom is getting too tired to push (and moms often say no), says Kung. Claudia Faille, president of the Quebec Midwifery Association, stresses that episiotomies are only done by midwives in emergencies.

While she’s thankful her episiotomy allowed Tase to be delivered faster, Kovarik admits she was unprepared for the painful recovery and that it took almost two months before she “felt normal down there.”

The main culprits in post-episiotomy (or tearing) discomfort are stitches and swelling. Kung recommends using an ice pack on the perineum on and off for at least the first 24 hours. Soaking in sitz baths with Epsom salts and cool water also reduces swelling and keeps things clean. Spraying the area with a stream of water while you pee eases the sting, and stool softeners can help prevent straining during a bowel movement. Acetaminophen and a topical anaesthetic spray containing lidocaine are good bets for pain relief.

If you’re still experiencing discomfort at your six-week checkup, be sure to tell your healthcare provider, and contact her immediately if you have increased pain, swelling, bleeding or foul discharge, as this could signal an infection.

The long-term complications of episiotomies are the same as with severe tears. Scar tissue is less stretchy and more likely to split with subsequent births, but Kung says tearing in general is less common after the first baby. The main concern is incontinence, so make sure you do those Kegel exercises to strengthen pelvic-floor muscles.

Ultimately, there’s no way to predict what labour and delivery will bring, so even if you’re dead set against having an episiotomy, don’t be hard on yourself if you end up having one. For Kovarik, the procedure may have been the difference between life and death for her little boy. “When they told me about the cord, I wasn’t questioning anything they were doing,” she says. “I just had to believe the doctors were doing what they had to to get him out.”

Expert tip
It can be hard for you or your partner to speak up when you’re lying on a delivery table about to birth a baby. If you’re worried about advocating for your wishes in the hospital, consider hiring a doula to be present at the birth. “No intervention should happen without consent,” says midwife Claudia Faille.

Read more:
Labour: My unexpected birth story
When labour is long: a survival guide
Should you get an epidural?

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