Today, episiotomies are rarely performed. But as recently as 1979, four out of five delivering moms were having the flesh between their anus and their genitals snipped during childbirth. What follows is an abridged version of the long, capricious history of the episiotomy.
There was a time when episiotomy — a surgical incision made in a woman’s perineum — was a routine part of childbirth in the United States, believed to help prevent the vaginal tears that can occur as babies emerge.
Episiotomy, a once-routine surgical incision made in a woman's vaginal opening during childbirth to speed the baby's passage, has been officially discouraged for at least a decade by the leading association of obstetrician-gynecologists in the United States.
As with many things about labor and delivery, there is a lot of conflicting information out there about episiotomies. Some people say they are never needed while other say that they can prevent more serious injury.
But for some women, it is a little snip that shapes how they experience and remember giving birth, and that can have lasting physical and psychic consequences.
Routine or prophylactic episiotomy (as opposed to episiotomy for specific indication such as fetal distress) is the quintessential example of an obstetrical procedure that persists despite a total lack of evidence for it and a considerable body of evidence against it.
In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma. Other findings, both in the short or long term, provide no clear evidence that selective episiotomy policies results in harm to mother or baby.
By 2006 The American Congress of Obstetricians and Gynecologists recommended physicians restrict the use of episiotomies due to a lack of maternal and fetal benefit, as well as the increased risk of complications such as tearing or anal sphincter dysfunction.
More than half a dozen scientific studies done since the 1990s suggest that those doctors were wrong. Episiotomies are actually associated with more postoperative pain, a much greater likelihood of tears in the anus (ouch), and other complications.
Routine episiotomies are almost never used anymore. Unless the baby is in serious danger, this outdated procedure should be avoided. Instead, the mother’s body should be permitted to react as it will, even if that includes tearing. Researchers indicate these lacerations are most likely to be less severe and less painful, and heal better and more quickly, than those created due to an episiotomy.
Which is best during delivery—episiotomy or natural tearing? During labor and delivery, a woman’s nether region will stretch and sometimes tear. Doctors may opt to do a procedure called an episiotomy to help in the delivery along. Not all women like the sound of having an episiotomy, and we can’t blame them, it sound scary and often women wonder how necessary is it to have one performed.
The first published account of episiotomy in a medical journal was in 1810, but it took another hundred years for it to become a normal part of obstetric practice. There are earlier reports from London in 1741. There has been considerable debate about the place of episiotomy - more often fuelled by preconceptions than evidence.