Ask any woman who’s had a baby about the worst part of the after-baby experience and you’ll probably hear: “the stitches.” What she’s talking about is the fall-out from having an episiotomy, a cut into the perineum (the area behind the vaginal opening) to enlarge the vaginal opening that is later stitched closed.

Fewer women are receiving this outdated and largely unnecessary procedure but some healthcare providers believe an episiotomy helps prevent damage to your soft tissues as well as protect the baby’s head as it travels the birth canal. Others believe episiotomy shortens labor, which may be true if the baby’s head emerges easier and faster, but it shortens labor by a few minutes at most.

Yet the consequences of episiotomy are much worse. In fact, episiotomy has been shown to do more damage than it prevents, except in very unique or emergency circumstances.

The Cut

To enlarge the opening, obstetricians make a cut in the midline from the vaginal opening toward the anus. When making this cut, they go through both the skin and the muscles lying under the skin. The cut is usually much longer and deeper than if the skin were to tear during labor instead. And because the cut is made in the direction of the anus, sometimes the cut can extend and cause damage to the muscles that keep the anus closed. This extension of the cut is called a 3rd or 4th degree tear.

Women who receive this cut risk increased bleeding during birth, prolonged healing and recovery pain and a more serious tear. When the cut heals, the scar tissue that has formed doesn’t stretch like healthy tissue and painful intercourse can result. Each subsequent labor and delivery may also be more painful as the vaginal opening won’t stretch and a bad tear or another episiotomy may occur.

Speak out against the cut

If you’re pregnant, ask your healthcare provider now about her or his practice regarding episiotomy. Ask if she or he will let your body tear instead of cutting your tissues. A tear is preferred because your tissues will only tear as much as necessary to allow the baby’s head through the vaginal opening. Tears also heal better although they are more difficult to sew closed.

Tell your care provider that you don’t want an episiotomy and include it in your birth plan. Indicate that you want to have any reason for an episiotomy explained carefully before you consent as a labor that is a few minutes shorter may result in years of pain for you.

This procedure might be more risky than beneficial so consider this before you give birth:

Benefits

• Might prevent damage to your soft tissue
• Shortens labor and protects your baby’s head
• Easier to sew back together than tears

Risks

• Might do more damage than it prevents
• Cut is usually longer and deeper than naturally occurring damage
• Muscles that keep the anus closed could be damaged
• Risk of increased bleeding
• Scar tissue can be painful

What to do

• Talk to your healthcare provider about their episiotomy practice
• Put your wishes in your birth plan
• Make sure to indicate that you want to have the reason for an episiotomy carefully explained before you consent