Expert Advice

Routine Episiotomies Are Medically Unnecessary

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Many times in life, we want to make the cut and be in the next-level group. But normal labor and birth isn’t one of those times. Episiotomy (eh-piz-ee-ah-tow-mee) is a cut made in your perineum (the space between your vagina and anus) to enlarge the vaginal opening. Routine episiotomies are medically unnecessary and now recognized as an outdated practice.

Increasing numbers of progressive institutions and care providers have already abandoned this practice. Except for high-risk situations, it’s an optional decision. Because it is your body, you have the right to say no to routine episiotomies. You can choose whether or not to have one by including your preference in your birth plan.

Modern medicine often trusts technology over natural processes. Episiotomy is the perfect example of this. Since the early 1900’s it became routine to give every primigravida (first-time mom) the “little snip”[1].

Back in the day, episiotomies were thought to prevent a drooping bladder and the rectum protruding into the vagina after birth[2]. It was supposed to help mom not tear when baby was pushed through the vagina and into the wide world.



Not only does the little snip not help delivery or prevent bladder or rectum problems, it often means:

  • a risk of deeper and longer tearing[4]
  • getting multiple stitches to correct it
  • prolonged recovery from an invasive medical intervention as well as healing your body after birth
  • having to care for the cut in addition to everything else that’s suddenly part of life with baby
  • a risk of infection
  • a risk of incontinence
  • possible loss of sexual pleasure[5]
  • having a scar that won’t stretch well for a subsequent birth, and could cause even greater tearing

Sometimes, an episiotomy is an intervention that can save a baby’s life. Some hospitals still believe an episiotomy is justified if a lot of vaginal tearing seems likely — if your baby is in an abnormal position or if baby needs to be delivered quickly. Emergencies are emergencies, and true ones can require radical measures[6]. During your birth planning research, you can find a modern care provider who will resort to using episiotomies only under emergency circumstances.

Most births aren’t an emergency. Most births can be managed by your expert care giver so mom either doesn’t tear at all, or has only a minimal tear. When you and your care provider discuss your preferences before the birth, ask about using slow delivery of the head to reduce tearing, instead of having an episiotomy. You can also ask about positions for pushing that help avoid tearing — even using your own hands on your labia and perineum to offer counter pressure.


An episiotomy weakens perineal wholeness and can tear beyond the little cut. When it does, it frequently tears worse than what mom would have experienced with a natural tear[7]. Instead of tearing on a superficial level, it can go into very deep tissues that require extensive stitches and longer healing time. Later, that big episiotomy scar can rupture during subsequent births.

Tears can heal better if they have the organic, irregular line that comes from a body naturally giving way to allow baby’s head to be born. Midwives and patient, skilled doctors can help guide baby’s head so your body has time to adjust. Your birth plan can say you prefer this method over a clean, surgical cut.

If you’re going to the hospital for your birth, include your most recent birth plan on your hospital bag checklist, and make sure it states your decision about getting an elective episiotomy.




To learn more about healthy pregnancy and birth, download our free Birth Plan eBook now. After three years of research, collaboration with more than 100 childbirth experts and resource centers from Healthy Child Healthy World to the American Association of Neonatal Nurses, the Best Ever Baby Birth Plan Guide is available for a free download.

This new resource for pregnant families is a compilation of top tips and advice from more than 20 nationally-recognized experts in the field including renowned pediatrician, Dr. Alan Greene and GraceFull Birthing founder, midwife Elizabeth Bachner.  These trusted experts offer thoughtful guidance for whatever type of birthing experience parents want, in whichever setting they choose.


Published: October 15, 2015 | Reviewed by: Kim Walls, Natural Products Expert, Elizabeth Bachner, LM, CPM, L.Ac., Midwife | Last reviewed: October, 2015



Kim WallsRoutine Episiotomies Are Medically Unnecessary

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