So in the 3rd trimester as people are preparing for delivery, they ask me all the time about episiotomy. So a lot of women will ask if they are common, as they used to be, and if they can avoid episiotomies. So the very simple answer is we do not routinely do episiotomies anymore. This was something that was very common in the 70s and the early 80s, and as we have developed more and more research in labor and evidence based medicine for labor, we've discovered that episiotomies are not at all routinely necessary. The only time that episiotomies may occur in modern medicine that is appropriate is if there's a complication with your labor, and your OB feels that it's appropriate to do an episiotomy to expedite delivery of your newborn. Some of the situations where that might be applicable are is if your baby is very large and the shoulders of the baby are stuck in the maternal pelvis. Sometimes an episiotomy may be helpful to deliver that posterior shoulder more quickly. Your obstetrician may also feel that if forceps or a vacuum are indicated because your baby is in distress, then an episiotomy may help again with rapid delivery of that baby.

Routinely, I describe to patients that an episiotomy, if you visualize a piece of paper that's intact, is like cutting the piece of paper at its strongest point. If you were to just tear the paper independently, the paper is going to tear at its weakest point, and that's the place that you want the paper to tear. You don't want to be cutting into the paper where it would be the most strong over time. So the same is true with an episiotomy. We don't want to cut into the strongest tissue that's going to have prolonged healing over time if we don't need to. We would rather, with good support of the baby's head and good perineal massage, prevent any tearing if possible, but also minimize the tearing to the weakest part of the vagina that would not be the strongest and the most important over time for incontinence issues. So I always tell patients if you're discussing this with a physician, remember that episiotomies now are not routinely practiced, and shouldn't be routinely practiced, because we know that they can lead to prolonged healing and worse incontinence than tearing at the natural weakest point of the vaginal area.

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