In most situations, if any tearing is going to occur, natural tearing has less risk and often heals better. Routine episiotomy increases the risk of severe tears, and long term perineal, vaginal, pelvic floor, and anal sphincter damage. An episiotomy rarely has benefits over a natural tear.
Like many historical shifts in doctor opinion, data drives why we no longer recommend routine episiotomies. The No. 1 reason the procedure has fallen out of favor is that it actually contributes to worse tearing than might occur naturally during childbirth.
Is it better to tear or have an episiotomy? The latest research suggests it's better to let the perineum tear naturally. Healthcare providers once thought making a surgical incision would help the vagina stretch and prevent severe tears.
natural tearing. Research has shown that moms seem to do better without an episiotomy, with less risk of infection, blood loss (though there is still risk of blood loss and infection with natural tears), perineal pain and incontinence as well as faster healing.
Long-term effects of episiotomies can include: Chronic pain and infections. A small linear scar. Anorectal dysfunction.
1st-degree tears
These are superficial wounds like abrasions or minor cuts that generally don't require stitches, and heal quickly (in a few days to a week). This is defined as only involving the skin. Perineal pain and soreness, or stinging during urination, are the norm in recovery.
But pain can stick around for 18 months or longer in up to 10% of those who had scarring after a vaginal delivery. What causes pain to resolve for some, but persist for others?
Episiotomy cuts are usually repaired within an hour of your baby's birth. The cut may bleed quite a lot at first, but this should stop with pressure and stitches. Stitches should heal within 1 month of the birth. Talk to your midwife or obstetrician about which activities you should avoid during the healing period.
The incision can be performed on either side and is generally 3-4 cm in length. The anatomic structures involved in a mediolateral episiotomy include the vaginal epithelium, transverse perineal muscle, bulbocavernosus muscle, and perineal skin. A deep or large mediolateral episiotomy may expose the ischiorectal fossa.
What is the difference between an episiotomy and a perineal tear? An episiotomy is a cut made by a health professional, while a perineal tear happens on its own during the second stage of labour. When a baby is being born, the perineum needs to stretch a lot and sometimes tears on its own.
Most women say they have less pain or discomfort after the first week. Most episiotomies heal in 3 weeks.
The Risks of Episiotomies & Natural Tearing
Not only is there a risk of infection at the incision site, other potential risks include injuries to the urethra, incontinence, chronic pain, and sexual dysfunction.
“Then you're condemning some women to an episiotomy who might've had a lesser tear or no tear at all if left to their own devices,” she said. Women have the right to refuse any procedure in the hospital, including an episiotomy, but they're not always aware that the doctor is about to perform one.
But many variables can affect how much lubrication your body produces. And if there isn't enough natural moisture created, tearing can occur. “Vaginal dryness is often part of the problem, because dryness creates friction, and that's the main reason the tears and abrasions occur,” says Dr. Evins.
Endometriosis in an episiotomy scar is extremely rare but can lead to significant morbidity in patients due to local infiltration. This condition can be diagnosed by the presence of the classical clinical triad of history of episiotomy, tender nodule at the scar site and cyclical pain.
The two main types of episiotomy are the median and mediolateral, although seven different incisions have been described in the literature. Episiotomy is classified into the following types: Midline, Mediolateral, Lateral, the modified-median, J-shaped, anterior, and radical (Schuchardt incision).
First-degree tear: The least severe of tears, this small injury involves just the first layer of skin around your vagina and perineal area. It usually doesn't require stitches.
A third-degree tear is a tear that extends into the muscle that controls the anus (the anal sphincter). If the tear extends further into the lining of the anus or rectum it is known as a fourth-degree tear. Image 1 shows a perineum without tears.
Fourth-degree vaginal tears are the most severe. They go through the anal sphincter and into the mucous membrane that lines the rectum. Fourth-degree tears usually need to be repaired in an operating room rather than in the delivery room.
If you've recovered well from your tear or episiotomy, and you have no symptoms from it, having another vaginal birth is likely to be an option for you .
However, as time passed and more research/observation was done, it turned out that episiotomies didn't actually heal better and they rarely healed faster. In fact, we eventually realized that having an episiotomy increased the risk of a more severe tear, infection, scarring and prolonged postnatal healing.