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Is an episiotomy necessary?
Q: I read that episiotomies may not be necessary, and in some cases are detrimental. I’m expecting my first baby and would appreciate hearing your thoughts on this matter.
A: In the last two decades, the routine use of episiotomy has been questioned. An episiotomy involves cutting the perineal skin, between the vagina and rectum, to widen the passageway for a vaginal birth. Episiotomies were traditionally thought to provide several benefits. It was assumed that they reduced pelvic trauma, lowered the chance for subsequent urinary incontinence (loss of bladder control) and pelvic relaxation (stretching and loosening of the vaginal and rectal tissues). Other proposed advantages included lessening pain following deliveries and enabling faster deliveries in situations where fetal distress was noted.

Newer research questions many of the traditional assumptions. It appears that there are higher rates of deep lacerations (called third and fourth degree lacerations) in women who receive episiotomies compared to women who deliver without them. Also, episiotomies may not prevent urinary incontinence or pelvic relaxation, as we had hoped. And, if a woman can deliver with intact skin or only minor lacerations, she may have less pain in the days after delivery and a more rapid recovery.

Most doctors and midwives recommend being selective about the use of episiotomy. Nationally, the frequency of the procedure has declined over the last three decades. First-time mothers with large babies are more likely to receive them, and fetal distress may prompt a health care provider to perform one in order to expedite delivery. There are specific techniques that may reduce the need for an episiotomy. (See my article on this web site titled, “Episiotomy” for more information on this subject.) Health care providers vary in their training and may have different attitudes about them. You should feel free to bring up this topic during your prenatal visits.