The Debate Over An Episiotomy – Is It Necessary?

Childbirth is painful – there’s no getting away from that. There are several pain issues to deal with before, during, and after delivery. One of the most debated procedures during delivery is the episiotomy. This incision is often described as the “unkindest cut of all.” It can often make recovery more painful than believed is necessary. What is it and is it necessary at all? Let’s look at the debate and you be the judge.

What is an Episiotomy?

Vaginal delivery is the natural form of birth. During this birthing process, when a mother pushes, she bears down so that she can move her baby through the vagina, or birth canal, and out into the world. The process can lead to possible stretching of the vaginal muscles, hemorrhoids, and weakness in the pelvic floor muscles.

In an effort to decrease the amount of pressure needed to push the baby through the birth canal, doctors may perform an episiotomy. This is an incision into the tissues of the perineum, the small area between the vaginal opening and the anal opening. The incision is believed to make birth easier with less stretching and damage.

If the mother is using natural, drug free, childbirth techniques, a local anesthetic is injected in the tissues of the perineum. A scalpel is used to incise the tissue. Once the baby is delivered, the area is sutured up.

There are different degrees of episiotomy performed depending on how large the child is or how difficult the labor. Usually the area is only cut halfway between the vagina and the anus with minimal skin layers incised. This is considered a second degree episiotomy. A fourth degree cut completely incises the skin layers.

What Now?

Who is right and who is wrong about the necessity of an episiotomy? Women who have had an episiotomy may disagree with the reasoning behind performing this procedure. Post-delivery, the episiotomy wound is difficult to deal with for many reasons. Simply urinating becomes a frightfully painful event, not to mention a bowel movement. Any straining or pushing during the healing process becomes unbearable. The wound stings, burns, and is often too sore to comfortably sit without some sort of ‘donut.’

There is no clear scientific evidence that supports having an episiotomy over not having one. Many women who have delivered babies with big heads or shoulders have recovered without any adverse effects and given birth quite successfully again. The vagina is made to stretch for the birth of a baby, so the reasoning behind an episiotomy is questioned by mothers as well as the medical profession. So, the debate continues. Let’s look at some possible side effects of having an episiotomy:

• Infections
• Uncomfortable or painful scar tissue
• Painful intercourse afterwards
• Longer recovery from delivery

So, is an episiotomy the “unkindest cut of all?” Discuss this procedure like you would any other with your doctor. An episiotomy should not be done as a matter of course, rather it should be approached as any other surgical procedure – with knowledge and caution.

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