Episiotomy: From Snip to Tear

Suzanne B. Robotti
Suzanne B. Robotti Executive Director
Last updated:

Episiotomies used to be a standard procedure with vaginal births. That’s changing as the procedure is seen as over-medicalization.

Episiotomies used to be routine procedure in the US for vaginal births, and I’m happy to report that’s changing. An episiotomy is a cut made with operating scissors from the edge of the vagina toward the anus (midline episiotomy) or angled off slightly away from the anus (mediolateral episiotomy).

I was taught about labor and delivery by Elisabeth Bing, cofounder of Lamaze International. She hated routine episiotomies for several reasons. First, doctors will do them to speed the delivery, and she firmly believed that labor should take as long as it needs to, as long as mother and baby are healthy. Even more importantly, doctors are taught that a small cut will avoid a possible (natural) tear. Bing refuted this belief.

Elisabeth would compare the skin and musculature around the vagina to a piece of woven cloth. Cloth is made of individual threads woven together for strength. Anyone who has worked with cloth knows that it is very sturdy and won’t fall apart or tear easily. However, if you simply snip the edge with a pair of scissors, it then tears easily. She contended that the episiotomy caused deeper tears.

Once again, Bing was correct. The Cochrane Review just reported that routine episiotomies are not justified medically. The Cochrane Review is a nonprofit, independent volunteer organization that conducts systematic reviews of randomized, controlled trials of healthcare interventions and drugs. The team reviewed 11 randomized, controlled trials with 5,977 women in terms of benefits and harms for mother and baby in women at low risk of instrumental (cesarean, forceps, etc.) delivery.

Episiotomies are an example of the over-medicalization of a natural process, childbirth.

They found that selective episiotomy (only when medically indicated) results in fewer deep tears (severe perineal trauma). It seems Elisabeth is right: A natural tear is less likely to be a significant injury than a scissor cut that tears further. The researchers couldn’t find any record of harm to mother or baby when the policy is selective episiotomy. What is clear is that the mother loses blood, requires stitching and runs the risk of infection or scarring with every episiotomy. With a non-episiotomy birth she has none of that risk or pain.

Here is an example of the over-medicalization of a natural process. Birth is hard, long and painful. Of course, doctors want to limit the pain and speed the delivery. But more and more science is finding that the very process of labor — the muscle contractions, the movement through the biome of the birth canal and the actual delivery of the baby, which then triggers the healing process within the mother’s body — has benefits for the baby and the mother.

Unless the mother’s or baby’s life is at risk, nature’s course is best.

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