Why you should choose neither a vaginal cut (episiotomy) nor a perineal tear
In this Papa’s Perspective series I share my own experience based on extensive reading, talks with midwifes and discussions with ob-gyns, but I am not a doctor. You should generally believe licensed medical professionals rather than internet articles when they offer contrasting advice.
Short version
You should strongly refuse routine episiotomies, but tell the ob-gyn that they can perform one if they believe a deep anal tear is likely or if the baby or mother are in distress.
Long version
One of the many choices you should make during the pregnancy phase is whether you want an episiotomy or not. An episiotomy is a procedure where the doctor or midwife makes a cut in the area between the vagina and the anus (this area is called the perineum, or more colloquially, the taint or gooch) in order to make more room for the baby’s head to come out.
This used to be the default procedure (and continues to be so in many countries, including Portugal, Poland and Cyprus) as it was believed that a clean cut would lead to fewer complications afterwards than a messy tear. The idea being that vaginas can stretch, but often not far enough and well, life finds a way — and then you’d rather control the circumstances.
Unfortunately, episiotomies can be nasty cuts, with sometimes long recovery times, prolonged pain during intercourse and they risk breaching the wall between the vagina and the anus, leading to nasty infections and intense pain. Nevertheless, they remain popular as the cut speeds up delivery, which matters a great deal to for-profit hospitals that need to clear out their maternity wards.
You might be tempted then to conclude that you should flat out refuse an episiotomy. However, you’d be wrong because ‘natural’ perineal tears are also nasty wounds, with sometimes long recovery times, prolonged pain during intercourse and they also risk breaching the wall between the vagina and the anus.
In fact, the figure above shows that women giving birth in low episiotomy-rate countries are more likely to experience deep wounds to the anal area, the most serious relevant complication. For this reason, the NHS (UK healthcare) recommends to cut when a deep tear is likely.
Moreover, when either the baby or the mother is in distress, speed is absolutely crucial and episiotomies win a lot of time and are usually required when the baby needs to be extracted with a forceps (a big spoon) or a ventouse (a suction cup).
Conclusion
What to choose then? In my personal opinion (not a doctor!) there is only one option that makes sense. You should strongly refuse routine episiotomies, but tell the ob-gyn that they can perform one if they believe a deep anal tear is likely or if the baby or mother are in distress. Why? Because a small tear is better than a cut, but a cut is better than a deep tear.
Disagree? Let me know!
