The thought of tearing during childbirth can be scary. Some medical experts are questioning the need for episiotomies. Learn the alternatives.
Incision Decision
During the third trimester of pregnancy, a woman has many things on her mind. One discussion she may over overlook is whether to have an episiotomy. This is a surgical incision made in the perineum, the area between the vagina and the anus, to enlarge the vaginal opening during childbirth. There are two types of episiotomy.
Midline Episiotomy
A midline episiotomy is a surgical incision made in the perineum during childbirth. It involves a straight incision made from the vagina toward the anus. Midline episiotomies were once performed routinely during childbirth, but they are now reserved for situations where there is a medical need.
Reasons for Midline Episiotomy
Midline episiotomy may be necessary if a baby’s heart rate drops significantly during labor, and expedited delivery is required to prevent complications. Additionally, if a baby is too large to pass through the vaginal opening, an episiotomy may be necessary to make more room.
Risks of Midline Episiotomy
Midline episiotomy can be painful and may require a longer recovery time than natural tearing. Additionally, studies have shown that routine episiotomies do not prevent severe tears or incontinence and may actually increase the risk of these complications.
Mediolateral Episiotomy
A mediolateral episiotomy is a surgical incision angled incision made to one side of the midline in the perineum during childbirth. In general, mediolateral episiotomies are less likely to result in severe tears or incontinence but have a higher risk of blood loss.
Reasons for Mediolateral Episiotomy
Mediolateral episiotomy may be necessary if a baby’s heart rate drops significantly during labor, and expedited delivery is required to prevent complications. Additionally, if a baby is too large to pass through the vaginal opening, an episiotomy may be necessary to make more room.
Risks of Mediolateral Episiotomy
Mediolateral episiotomy is associated with a higher risk of blood loss than midline episiotomy. Additionally, like midline episiotomy, mediolateral episiotomy can be painful and may require a longer recovery time than natural tearing. However, studies have shown that mediolateral episiotomy is less likely to result in severe tears or incontinence than midline episiotomy.
Alternatives to Episiotomy
If you have concerns about the possibility of an episiotomy during childbirth, there are several things you can do to help reduce your risk. These include:
- Discussing your preferences and concerns with your healthcare provider before delivery
- Asking your healthcare provider about their policies and practices regarding episiotomies
- Practicing perineal massage or other techniques to prepare the perineum for childbirth
- Using warm compresses or other pain management techniques during delivery
- Using controlled pushing techniques to reduce the risk of tearing
Ultimately, base the decision to perform an episiotomy on medical necessity and a discussion between you and your healthcare provider. If you have questions or concerns about episiotomy or other aspects of childbirth, be sure to discuss them with your medical team.
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