When you’re choosing where to give birth, it’s important to remember that certain hospitals, birth centers, and providers have policies and practices that impact birth outcomes—which is why it’s important to find out about episiotomy rates.
An episiotomy is a surgical incision made in the perineum (the tissue between the vaginal opening and anus) during vaginal delivery. Just a decade or so ago, episiotomies were considered a routine procedure meant to help prevent further tearing, but thinking on episiotomies has changed, and the rate of episiotomies today is relatively low.
What are the guidelines for episiotomies?
Like many aspects of pregnancy and childbirth, the medical guidelines for episiotomies have changed with new advances in healthcare. Previously, doctors believed that episiotomies prevented excess vaginal tearing during delivery. It was thought that having an episiotomy also helped women heal faster and preserved the connective tissue in the pelvic floor.
But modern research doesn’t support these claims. Research suggests that routine episiotomies carry many risks and can actually slow postpartum recovery. The American College of Obstetricians and Gynecologists (ACOG) recommends against episiotomies except in cases where the procedure is medically necessary. Granted, medical necessity is easier said than explained, as it can be a bit of a moving target; more on that below.
Is a low episiotomy rate good?
Although there are definitely cases where you can’t or shouldn’t avoid an episiotomy, researching episiotomy rates can help provide a clearer picture of your chances in general. When a hospital has a low rate, it generally means that episiotomies are only performed in situations where they are actually medically necessary, such as when the health of the baby or mother is at risk.
Experts think that the rate of necessary episiotomies is about 5 percent of live births or less, and therefore recommend that hospitals should aim to keep their episiotomy rate under 5 percent. According to ACOG, “The best available data do not support the liberal or routine use of episiotomy. Nonetheless, there is a place for episiotomy for maternal or fetal indications such as avoiding severe maternal lacerations or facilitating or expediting difficult deliveries.” Granted, the rate has been much higher: The rate of episiotomy with all vaginal deliveries decreased from 60.9 percent in 1979 to 24.5 percent in 2004 and is about 14.1 percent today.
Understanding episiotomy rates can help you make informed healthcare decisions and choose the best options for you and your family. With Motherfigure’s hospital directory, you’ll find data about episiotomy rates as well as C-section rates and more.
Let’s take a closer look at episiotomy and see why this procedure should be avoided.
Are episiotomies medically necessary?
According to the Mayo Clinic, an episiotomy is deemed medically necessary if the baby needs to be delivered quickly due to complications. Common reasons to have an episiotomy include:
- The baby has an abnormal heart rate or other signs of distress
- Shoulder dystocia, a condition wherein the baby’s shoulder becomes stuck behind the mother’s pelvic bone
- The baby’s head is too large for the vaginal canal opening
- The baby has a complicated breech position
- The mother needs an intervention during delivery using forceps or vacuum
- The mother isn’t able to control her pushing
You may have heard that perineal massage during pregnancy can help prepare your body for childbirth by priming the skin to stretch. Women having their first baby, those who are 30 years or older, and people who have had episiotomies before tend to have fewer/less severe tears when perineal massage is performed during the last weeks of pregnancy. You can learn more about that here.
What are the different types of episiotomies?
There are two types of episiotomies. Before performing either type, your doctor or midwife might begin by administering a local anesthetic. You most likely won’t feel the episiotomy incision, especially with contractions and the other physical processes happening to your body during labor, but you will feel it later.
After the anesthetic takes hold, the doctor will make one of two types of episiotomy incisions. Which type of incision is made depends on a variety of factors, including what’s best for mom and baby.
Type 1: Midline or median incision. In a midline or median episiotomy, the incision is made vertically. This type of episiotomy is easier to repair and heals more quickly. However, it has a higher risk of further tearing downward into the anal region.
Type 2: Mediolateral incision. This type of episiotomy is made at an angle. The incision is less likely to extend into the anal tissue, but it often takes longer to heal and can be more painful during the recovery phase.
What are the risks associated with episiotomies?
Childbirth obviously places a huge strain on your body. Regardless of how childbirth unfolds, healing from it takes time and can be difficult to do while you’re also caring for a newborn and adjusting to the attendant lack of sleep. Postpartum recovery is hard enough, even after a “normal” pregnancy.
However, there are specific risks associated with episiotomies beyond the extra healing time. As you research episiotomy rates, you’ll find many complications associated with the procedure.
Among the risks of having an episiotomy, women have reported:
- Additional tearing and infection around the incision site
- Bruising, swelling, and bleeding
- Pain during sex in the months after delivery
- Pain while urinating or defecating
- Urinary incontinence
- Fecal incontinence
Midline or median episiotomies, in particular, pose a significant risk of fourth-degree vaginal tearing, in which the tear can extend into the mucous membrane lining the anal sphincter. This can result in additional complications.
Episiotomy recovery and treatment
Even if you give birth in a hospital with a low rate for episiotomies, there may still be circumstances where you need one. But don’t be afraid to ask questions and make sure you understand why your OB or Certified Nurse Midwife is recommending it. As always, remember that there’s no right or wrong way to give birth as long as you and your baby are healthy.
After having an episiotomy, your doctor will most likely use stitches that can be absorbed by your body. You may also be prescribed certain antibiotics, pain relievers, and stool softeners to take during your recovery. Some experts also recommend cold packs, sitz baths, and using a squirt bottle instead of wiping after using the restroom. (We’re special fans of the padsicle: Take a pad, put witch hazel on it, and pop it in the freezer for cold, healing comfort. Our performance leggings happen to offer an ideal subtle cradle for your pad or padsicle, too!)
Your pain and discomfort will lessen as time passes and your episiotomy incision heals. However, be sure to see your healthcare provider right away if you develop a fever, your pain intensifies, or you experience pus-like discharge, as these can be signs of infection.
Healing your episiotomy scar
Many women don’t realize that the scar that stems from episiotomies—or tearing in general—can be the source of further discomfort. Like any other scar, the key to returning to full function in the area is to get that scar moving!
When it comes to healing your episiotomy scar, there are a few things you can do:
- Gentle clock stretches at the vaginal opening: This six-step massage technique is outlined here; just remember to use a lubricant that doesn’t contain any alcohol.
- Perineal massage: Place two lubricated thumbs into the vagina, gently press downwards for 30 seconds to three minutes, and repeat. Do this several times in a row, as tolerated.
- Using a cold pack: After stretching, you might feel tender. Apply a cold pack wrapped in a towel or T-shirt for up to 10 minutes. This will help decrease inflammation and pain.
Make informed decisions with episiotomy rates
By researching the episiotomy rates of your local hospitals, you’ll be empowered to make better choices about your prenatal care. Use the Motherfigure directory to find out about episiotomy rates and more.
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