Pregnancy Diary

If you are planning on a vaginal birth,whether or not to have an episiotomy is an important decision to consider. It is best to know all the options available before labor begins, so that your birth plan expresses your specific wishes.

There are two main types of episiotomies – the midline and the mediolateral. The midline is when the doctor makes the incision straight down towards the anus, and the mediolateral is an incision made diagonally to help avoid a later tear into the anal area. It is used to be done routinely during a vaginal child birth by the doctor or midwife as a way to help the woman avoid getting a tear.But today many women say no to it.

The positive aspects can include:

• Faster birth
• Prevention of tearing
• Protection against incontinence
• Protection against pelvic floor relaxation
• Faster rate of healing than tears
While the negative aspects include:

• Infection
• Increased pain
• An increase in 3rd and 4th degree vaginal lacerations (euphemistically called extensions)
• Longer healing times
• Increased discomfort when intercourse is resumed

Many midwives believe that there are better ways to avoid a tear than getting an episiotomy. These might include:
• Good nutrition (healthy skin stretches more easily)
• Kegels (exercise for your pelvic floor muscles)
• Prenatal discussion with your care provider about episiotomy
• Prenatal perineal massage
• A slowed second stage (controlled pushing)
• Warm compresses, perineal massage and support during delivery