What is Your Episiotomy Rate?

Know Your Care Provider's Episiotomy Rate

It's important to inquire about your obstetrical care provider's episiotomy rate so you can feel comfortable with the care they will provide.


What is your episiotomy rate?


Episiotomy should only be done if there is fetal distress while crowning, or it looks like the tissues will have a big blow-out. (Perineums heal, baby brain cells without oxygen don’t; that is why we monitor so closely while pushing).  Most spontaneous tears are first degree (only through the subcutaneous tissue). An episiotomy is a second degree tear through the beefiest part of the perineal muscle, and can frequently extend into a third or fourth degree tear right through the rectal sphincter or rectum itself.  If crowning is allowed to go slowly, allowing your tissues to stretch and accommodate, and the birth is encouraged to go slowly at this point with the help of olive oil and warm compresses, good perineal support is given by your birth attendant, and physiological pushing is encouraged instead of directive pushing, tears are usually minimized, and if they occur are much less severe than episiotomy wounds.  Left side lie is a good position to minimize tearing.  Also birthing on all fours is helpful to reduce tearing and preventing shoulder dystocia (stuck shoulders).  If women were meant to have episiotomies, women would have been born with zippers there.  The vagina is like a fan.  It normally is small, but has tremendous potential space to expand to birth our babies.

Sources:

  • ACOG Recommends Restricted Use of Episiotomies, March 31, 2006
  • Practice Bulletin #71, "Episiotomy,"  April 2006 issue of Obstetrics & Gynecology.