I laughed. I know I shouldn’t have, but I did. When I visited my best friend in the hospital after she had her baby and saw her waddle across the recovery room, all I could do was laugh. It turns out she had suffered from a serious laceration during birth and they had given her a pair of disposable panties they had prepared with a thick maxi pad, an ice pack, witch hazel pads, and estrogen foam. The result was a pair of panties so lumpy she could barely walk. Fortunately, she was in good humor about the whole thing and giggled right along with me.

The next day, however, we had a serious conversation about the delivery experience and I could understand the post-baby waddle to a new level. Because she is my best friend I had the confidence to ask a squirmy question—didn’t you get an episiotomy? I thought this was just common practice when a woman was delivering. I figured it just came as part of the moment the doctor realizes the baby was on its way out. What I learned, however, is this is not the way it is. So what is the truth about episiotomies and lacerations?

Many mothers may go into the labor and delivery process wondering if they will be subjected to a routine episiotomy. Thanks to extensive research into the benefits of such a procedure, the answer is most likely “no.” The majority of birthing facilities have come to avoid performing episiotomies except in the instances of extreme emergency, meaning that most mothers will not undergo such a procedure. An episiotomy, which is a deliberate incision created through the perineum prior to the delivery of a baby’s head, was once considered a routine and essential element of the birthing process. It was believed that such an incision would prevent serious perineal trauma, fecal and urinary incontinence and postpartum sexual dysfunction, and heal more easily than lacerations. These concepts have since been proven inaccurate.

Studies have indicated, in fact, that episiotomies may actually be responsible for worsened lacerations. By incising the perineum, the integrity of the area is removed. Pressure from the delivery then tears the tissue, often in a horizontal or diagonal manner rather than vertically. Short-term outcomes of episiotomies include third-and fourth-degree lacerations to the perineum and rectum, blood loss, severe pain, and difficult wound healing. Effects over the long term can include permanent defects to the pelvic floor, lasting incontinence and negatively-impacted sexual function. On the other hand, women who experience natural lacerations and receive effective care including skilled suturing and tissue support, heal much more effectively with fewer lasting effects.

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.

Source: Hartmann K, et al. Outcomes of routine episiotomy: a systematic review. JAMA. 2005; 293: 2141-2148