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Considering Episiotomy

When is an episiotomy a choice versus a necessity?

woman patient talking to her doctor

Being pregnant is an exciting and anxious time. You may want to jump straight to picking out names and nursery items. But first, there are a few medical decisions and choices you’ll need to think about. Here are some to consider:

  • What kind of health professional you want to work with for your prenatal care, labor and delivery
  • What prenatal testing you will have
  • The plans you want to follow at the baby’s birth, such as who may be present and who will cut the baby’s cord
  • Where and how you’d like your baby to be delivered
  • Your preference about episiotomy

Some of these are choices you can make. Others may be made for medical reasons. One decision to discuss with your doctor is an episiotomy.

What is an episiotomy and why would I need one?

An episiotomy is done to widen the opening for giving birth. For this procedure, a surgical cut is made in the area between the vagina and the anus. This area is called the perineum. This cut is to help prevent tearing of the perineum tissue. It widens the area through which the baby’s head, shoulders and remainder of the body can move during delivery. It can help ease the delivery of the baby. This may help deliver the baby more quickly in an emergency situation. The incision is stitched closed after delivery with absorbable stitches.

Is an episiotomy a routine part of delivery?

Having an episiotomy used to be a common part of delivery. In recent years, the percentage of episiotomies has dropped dramatically. They have gone from nearly 61 percent of vaginal deliveries in 1979 to about 25 percent in the mid-2000s. Studies reversed earlier thinking that episiotomies shorten labor and reduce the risks to the mother and baby.

Today, an episiotomy is done only selectively. It is considered medically necessary when a baby is having trouble during delivery. Studies have shown that nurse midwives perform the fewest episiotomies. Upright birthing positions decrease the need for episiotomies. They are more common with first-time deliveries. The most common complications of having an episiotomy include infection and bleeding.

When should I talk to my doctor about my preferences?

Start your discussion with your doctor or midwife long before labor. At one of your early prenatal visits, discuss your initial thoughts and preferences. Ask if he or she has a policy of routine episiotomy. Ask your doctor or midwife under what conditions he or she would consider an episiotomy medically necessary. Make sure your doctor or midwife supports your preference not to have an episiotomy unless it is medically needed.

By Mary Small, Contributing Writer

American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth: Month to Month. 6th ed. Washington, DC: ACOG; 2015.
UpToDate. Approach to episiotomy. Accessed: July 7, 2016.
KidsHealth. Birth plans. Accessed: July 7, 2016.
March of Dimes. Pregnancy. Stages of labor. Accessed: July 7, 2016.

Last Updated: July 7, 2016