For decades, episiotomies (surgical cuts during birth) were routine. Today, we know they aren’t always necessary—and natural tearing is often easier to heal.
So, when is an episiotomy recommended? And what are the risks and benefits compared to natural tearing?
This guide will cover:
✔️ Why episiotomies were once common & why they’re now discouraged
✔️ How episiotomies compare to natural tearing
✔️ Ways to reduce your risk of needing one
What Is an Episiotomy?
📌 An episiotomy is a surgical cut made in the perineum (the area between the vagina and anus) during birth to widen the vaginal opening.
✔️ It’s done with scissors or a scalpel as the baby is crowning.
✔️ The incision is then stitched after birth with dissolvable sutures.
✔️ Used to be routine in 90% of hospital births but has dropped significantly.
📌 Pro Tip: Many people can birth without tearing or needing an episiotomy—choosing a supportive provider helps.
💡 Related Post: Tearing During Birth: What to Expect & How to Heal Faster
Why Were Episiotomies Routine?
For years, doctors believed:
✔️ A clean surgical cut would heal better than a natural tear.
✔️ It could prevent severe tearing.
✔️ It would speed up labor & delivery.
📌 We now know that these assumptions were wrong. Research shows episiotomies often cause more pain, slower healing, and increase the risk of complications.
💡 Related Post: Understanding the Stages of Labor: What to Expect from Start to Finish
Episiotomy vs. Natural Tearing: What’s the Difference?
| Factor | Episiotomy | Natural Tearing |
|---|---|---|
| Healing Time | Longer (weeks to months) | Shorter (2-6 weeks) |
| Pain Level | Higher (deeper cut, more stitches) | Varies (mild to moderate) |
| Infection Risk | Higher | Lower |
| Likelihood of 3rd/4th Degree Tear | Higher | Lower |
| Risk of Future Pelvic Floor Issues | Higher | Lower |
📌 Pro Tip: Episiotomies often lead to larger, more painful tears extending into the rectum. Natural tears tend to be smaller, more shallow, and heal faster.
💡 Related Post: Pain Management Options for Labor: From Natural to Medical
When Is an Episiotomy Necessary?
📌 Episiotomies are now considered an emergency intervention—not routine.
🚼 An episiotomy may be needed if:
✔️ Baby is in distress and needs to be born quickly.
✔️ Forceps or vacuum are required for assisted delivery.
✔️ Baby’s shoulders are stuck (shoulder dystocia).
🚼 An episiotomy is NOT necessary if:
❌ A provider prefers it for “convenience.”
❌ Baby is crowning normally, and tissue is stretching well.
❌ You’re pushing but progressing steadily.
📌 Pro Tip: If your provider has a high episiotomy rate, it’s a red flag! Ask ahead of time about their approach.
💡 Related Post: How to Advocate for Yourself in Pregnancy & Birth
How to Reduce Your Risk of Episiotomy or Severe Tearing
✔️ Choose a Provider with a Low Episiotomy Rate – Ask during prenatal visits!
✔️ Do Perineal Massage – Start around 34-36 weeks to improve elasticity.
✔️ Use Warm Compresses on the Perineum During Pushing – This reduces tearing.
✔️ Avoid Lying on Your Back to Push – Upright positions (hands & knees, squatting) help tissues stretch naturally.
✔️ Push Slowly & In Control – Letting the perineum stretch naturally reduces tearing risk.
📌 Pro Tip: Many midwives and birth-friendly OBs use a “hands-off” approach during pushing to allow for natural stretching.
💡 Related Post: How to Create a Birth Plan That Actually Works
Birthify’s Expert Support for Birth Planning & Recovery
💛 Want to avoid unnecessary interventions like episiotomies? Need postpartum recovery support? Birthify’s birth experts provide real-time coaching to help you feel informed and prepared.
👉 Join Birthify today and get expert-led birth support! Sign up here