Episiotomy: Is it better to tear or be cut?

We have seen a dramatic decline of almost 50 percent in the use of routine episiotomy in the U.S. over the past 20 years. (Obstetrics and Gynecology, March 2001) This can be attributed to the number of women who are questioning the use of any routine procedure in childbirth, as well as the growing numbers of nurse midwives.

The term "tearing" conjures up images that most women would rather not consider. I always explain to my clients that the decision to perform an episiotomy is made during the last few pushes, but there are actions she can take to maximize her chances of birthing with her perineum intact.

Perineal massage is one technique that has been shown to be beneficial in preventing lacerations (tearing) and reducing the need for an episiotomy. Maintaining a good diet and preventing anemia (low iron) also improve skin condition. Trying to avoid excess weight gain prevents fetal excess growth, which can improve the chances of delivering with perineum intact.

At the time of birth, minimizing the use of regional anesthetics, such as epidurals, may help the mother work with her care provider to control her pushing and obviate the need for vacuum or forceps deliveries.

To prevent lacerations, it is important to listen to the midwife or doctor carefully and to give small controlled pushes. Occasionally, the mother may be asked to push between contractions so the force of the contraction does not cause her to push uncontrollably.

Lacerations are often small and do not extend into the muscle. When an episiotomy is cut, several layers of tissue and muscle are incised. Lacerations often extend just into the superficial tissue.

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