What I Wish I Knew About Episiotomies

Image adapted via Flickr/ Raphael Goetter

When I was nearing the end of my first pregnancy, I had a lot of questions about what labor and birth were going to be like. Was it going to be as painful as everyone said it was going to be? Would I get an epidural in time? Would I need to be induced or have a c-section?

One thing that never did cross my mind was if I would have an episiotomy. According to the Mayo Clinic, an episiotomy is defined as “an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth.” They used to be a routine part of childbirth, but research now suggests episiotomies do not prevent a lot of the complications they thought to prevent in the past.

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I had read about episiotomies and heard about them in my childbirth class during my pregnancies, but I read that they don't happen often, so I didn't give it a second thought until I was delivering my first child and the doctor, after 12 hours of labor, said, “I need to give you an episiotomy.”

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My son wasn't tolerating labor well, and after a very scary few hours of interventions and questions, I had one shot to get him out fast, and thus, I needed the episiotomy. My son was born not breathing and was whisked to the other end of the room with the pediatric team, that was standing by, and while everything turned out to be fine with him in the end, I was left to heal from my “surgical vaginal delivery.” I wish there were some things I knew beforehand about episiotomies before I received one during my first birth.

It's hard to say “no” when you're worried about your baby.

My labor already had more interventions than I had hoped for, and I really wanted to avoid any more, but when the doctor and nursing staff tell you your baby is not doing well, you listen to whatever they say. I was technically asked if it was OK for them to do an episiotomy, and really, I am glad they did whatever they had to in order to bring him safely into the world, but it's hard to say “no” when you're scared. I can see how other women say they feel pressured into medical decisions in childbirth – while that's not what I felt, it's hard to say no.

It doesn't sound like a big deal.

Episiotomies were common when our parents were having children, and it doesn't sound like that big of a deal–it's just a small cut instead of a tear. But it's not quite like that. It is a big deal. A medical intervention and an unnatural incision take longer to heal.

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There are possible complications.

It's a surgical procedure, and as with any other one, there is potential for complications. According to Johns Hopkins Medicine, possible complications include “bleeding, tearing, pain, infection, scar tissue, Perineal hematoma, and pain during intercourse.” Years after my episiotomy, I still had pain and issues from the difficult healing process.

There are special instructions for after care.

I had many stitches after the birth of my first child from the episiotomy and natural tears on top of that. I didn't take care of the stitches well, and they tore a few days after delivery, which opened a whole new set of issues for me. There are special aftercare instructions for a childbirth that involves an episiotomy, and if you're not following them, you can risk more issues like pain, infection, and bleeding.

Johns Hopkins Medicine recommends the use of ice packs, sitz baths, medicated creams to reduce swelling and pain, and to keep the area dry and clean during healing. They also recommend you discuss with your care provider if you need pain medication.

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It would be harder for me to heal than when I had natural tears.

I was scared to have another delivery after my first child was born because the healing took so long. During the birth of my second child, a physician was not present (labor was slow, but birth was fast), and since only a physician can perform the surgical procedure, I delivered without an episiotomy. I still experienced a lot of tearing and needed many stitches, but the healing process was so much easier. The natural tearing was not a straight line, but being natural, my skin healed together with so much more ease, and I didn't experience any post-birth complications.

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Did you have an episiotomy? What was your experience like? Share in the comments.

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What do you think?

What I Wish I Knew About Episiotomies

Devan McGuinness is the founder of the online resource Unspoken Grief, which is dedicated to breaking the silence of perinatal grief for those directly and indirectly affected by miscarriage, stillbirth and neonatal death. Using her own experience of surviving 12 miscarriages, Devan has been actively supporting and encouraging others who are wading through the challenges associated with perinatal and neonatal loss. Winner of the 2012 Bloganthropy Award and named one of Babble's “25 bloggers wh ... More

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  1. Aubrey says:

    I had an episiotomy with my son (born 3 weeks ago)….my doc didn’t ask, he just did it and I wasn’t even aware that he did it; I also had a tear as well. I had two sets of stiches…one set up from the tear, the other set down from the cut. For me, the tear was more painful during the healing process then the cut. I babied both sets of stitches and was healed about 10 days after. The only pain medicine I needed was Ibuprofen 600 mg, taken once during the evening. To have an episiotomy of course is a personal decision (if you are given the choice to choose). I personally would not be opposed to having one again, but had I had a different healing/pain outcome, I probably would have a stronger opinion. Just like everything else we make decisions on, some people will choose to have one and some won’t based on their own personal reasons.

  2. Claudia says:

    Lucky for me I’m a bit of a book worm so when I found out I was pregnant with my first child I researched on everything pregnancy and decided not to go with the episiotomy for many reasons. I told my RN as soon as I could when I arrived at the hospital to deliver that if I could avoid one I would rather do that. So when the doctor pushed for one once it was time to push for no apparent medical reason, I was so grateful to my nurse that she spoke on my behalf when i was to tiered and distracted to speak for myself.


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