Is Episiotomy Better than Natural Tearing: What’s the Best Choice?
Many expectant mothers are concerned about the possibility of perineal tear or an episiotomy during childbirth. Both natural tearing and episiotomy are common outcomes for vaginal deliveries, but which is best? Is episiotomy better than natural tearing? Is the natural tearing process of the body a better or safer way to recover?
This article will explore the differences, and examine the situations where one may be preferred over the other. We’ll also look at both the positive and negative outcomes. David Addenbrooke is an experienced obstetrician, co-author and expert on Nine months: The Essential Australian guide to pregnancy. He offers his expertise to help demystify the two aspects of childbirth.
Understanding Natural Tearing
David Addenbrooke says that “tearing is normal and two thirds of women will shed some tears for the first time.” It is common for women to experience tears during delivery. This is a natural and expected process. The vagina will usually stretch to accommodate the newborn, but the skin may tear in some cases. This is especially true if your baby has a large head, if you have a less elastic perineum, or if you are pushing very hard.
Although some women are afraid of tearing, you should know that the severity can vary. Minor tears (first degree) may only involve a small cut on the vaginal tissue. However, more serious tears (second or third degree) can reach the perineum and even the anal sac. The majority of tears, however, are only first-degree and heal with no complications.
David says that many factors can influence whether a woman tears, such as the size of her baby, its position during delivery, whether she uses instruments like vacuums or forceps, and how she pushes. David explains, “I’ve watched some women tear up with a 5-pound baby and I’ve also seen others lift an 11-pound child out of their arms. Important to remember is that genetics and the production of collagen play a part. Some women’s body heals faster than others.
What is an Episiotomy?
A surgical episiotomy involves making an incision in the vaginal opening to make room for the newborn during delivery. This procedure is designed to prevent more severe or irregular tears by determining where they will occur. David explains the episiotomy procedure is done under local anesthesia. This means the area will be numb to prevent any pain. This procedure can be done with scissors quickly and is considered to be low-risk.
A doctor or midwife will plan and perform an episiotomy, which is different from a natural tear. It may also involve stitches to close the wound after birth. Some women choose an episiotomy based on medical advice. Others may opt for it as a precautionary procedure if they experience fetal distress, or need forceps during delivery or vacuum assistance.
David stresses that episiotomy is not routinely used in childbirth. He says that episiotomies are not done for fun. The best outcome for a woman is to not tear at all or, if she does tear, that the tear is small and easy to repair. Episiotomies are common in certain settings but they’re reserved for cases when it is necessary to prevent severe tears or complications.
When Is an Episiotomy Necessary?
In several situations, an episiotomy can be considered.
- Fetal Distress: An episiotomy can be performed if the baby’s heartbeat drops or if there are signs of distress. The goal is to have the baby emerge more quickly and reduce the risk of injury.
- Instruments: An episiotomy may be recommended when forceps, vacuums or other instruments are used during delivery. This creates more space and reduces the chance of damage or uneven tearing.
- Prolonged Pressing: An episiotomy is needed if a mother pushes for a long time without making any progress. This is especially true if a mother is tired or if her baby’s head does not move forward as it should.
- Severe Tearing In some situations, especially with large babies and complicated positions, it may be necessary to perform an episiotomy to prevent a severe tear from extending into the anus. It is important to prevent third-degree and fourth-degree tears.
What is the difference between episiotomy and natural tearing?
Answering this question is dependent on the circumstances of the delivery. Both natural tears and episiotomies are good and bad, but it’s important to know that they each have their pros and cons.
David says that natural tears heal more quickly and comfortably than episiotomies in most cases. He says that if the tear occurs gradually, and the tissue is neatly broken, a tear can heal more quickly and comfortably. Many women only experience minor discomfort from natural tears. The body can often heal itself without any additional intervention.
Some natural tears, however, can cause more problems. David says that a natural tear can occur in a hundred different directions. It can tear upwards towards the clitoris, or downwards towards the anal muscles. This can cause long-term pain or complications.
In such cases, an episiotomy may be used to reduce the risk of a more severe tear. The recovery after an episiotomy is usually more painful, since the incision needs to be healed and stitched. An episiotomy can feel more invasive to many women and heal slower than a minor tear.
Second Time Around
Women who had an episiotomy during their first birth or experienced tearing often wonder if they will tear again in subsequent births. David says that women tend to tear less the second time, whether or not they experienced an episiotomy during their first childbirth. He says that the more children you have, he says, the less likely you are to tear. The perineum, and the vaginal tissue tends to be more elastic after the first delivery. This makes it easier for your body to stretch in subsequent deliveries.
Can Tearing be Prevented?
There are ways to reduce the risk of tearing. Perineal massage is a common way to prevent tearing during childbirth. This involves gently stretching out the perineum weeks before labor. This encourages the muscles to become softer and more flexible.
David says that the goal of a perineal massaging is not to stretch tissues to increase the opening, but rather to improve the flexibility of the muscles. Midwives and obstetricians may also use other techniques during labor. For example, they can support the perineum using warm compresses. This will reduce the risk for tears.
Recovery and Aftercare
You will need to take care of yourself whether you have an episiotomy or a tear. It is normal to experience some swelling, bruising and discomfort after an episiotomy. David says that the majority of stitches will heal in a month and most pain should subside after a few months.
Many women who have had an episiotomy find relief from pain by taking painkillers such as paracetamol and ibuprofen. Ice packs are also effective in reducing swelling and discomfort. Keep the area clean, dry and free of bacteria by following proper hygiene. It is important to consult a doctor if pain persists, or if there are signs of infection.
Conclusion
Both episiotomies as well as natural tears have advantages and disadvantages. Episiotomies can prevent more severe tears, especially when instruments are being used or there is fetal discomfort. In many cases, however, the natural tearing can heal faster and cause less discomfort.
The decision to perform an episiotomy will ultimately be made by the midwife or obstetrician, who will take into account the circumstances of each birth. The goal of any episiotomy is to provide a safe, healthy birth for the mother as well as the baby.
Understanding your options, and talking to your doctor about them is essential for you to make the right decisions in your specific situation.
