Episiotomy itself is an important source of injury in that it cuts muscles and nerves. A study found that even an episiotomy that did not extend, tripled the risk of fecal incontinence and nearly doubled the risk of gas incontinence (18). As for preventing overstretching and subsequent weakness, episiotomies are not done until the baby's head is about to be born, which means the vagina is already fully expanded. The trial, randomly assigning women to liberal or restrictive use of midline episiotomy, found that women with no episiotomy or tears had the strongest pelvic floors, followed by women with spontaneous tears (13). Women having episiotomies, and especially those whose episiotomies extended, had the weakest pelvic floors.
Easier repair and improved healing: The deep tears episiotomies can cause are certainly more difficult to repair than the minor ones that may occur when no episiotomy is done. A study looking at healing in women with and without episiotomies reported that delayed healing occurred four times more often in women who had episiotomies (eight percent versus two percent) (16). The difference remained even after removing women with an intact perineum (no injury to the block of tissue between the vagina and the anus) from consideration, which suggests that spontaneous tears heal faster.
Reduction in pain: The random assignment trial evaluating midline episiotomy reported that women with no tears experienced the least pain in the postpartum period, followed in order by women with spontaneous tears, women with episiotomies, and women whose episiotomies extended (13).