Rates are half of what they used to be, but too many women are still having this surgical procedure during delivery. Here's how to lower your odds of an episiotomy.
If you're nervous about needing an episiotomy (a surgical cut at the end of the vagina to make delivery easier), good news: Fewer and fewer births involve the procedure. One in four vaginal deliveries in the U.S. used the procedure in 2004, but in 2006, the American Congress of Obstetricians and Gynecologists (ACOG) recommended against routine episiotomy, noting that the snip increases the risk of pain, laceration and anal incontinence. Thankfully, labor docs listened: Between 2006 and 2012, the rate dropped from 17.3% to just 11.6%, according to new research published in JAMA.
The study—which looked at more than 2,000,000 women who gave birth in more than 500 hospitals during that time—also found that rural hospitals and teaching hospitals had lower episiotomy rates, and that white and Hispanic women were almost twice as likely to undergo the procedure as black women. While the study didn't address why some populations and hospitals see higher rates, "certain people are trained to do certain things in specific populations," says Alexander M. Friedman, MD, lead researcher and an assistant clinical professor of maternal-fetal medicine at the Columbia University College of Physicians and Surgeons. "Instead of acting on evidence-based recommendations, providers may be acting based on their training or what the institutional environment is."
While episiotomy rates have dipped overall, some hospitals are still performing them on the regular: The 10% of hospitals with the highest episiotomy rates used the procedure in 34.1% of all deliveries, while the hospitals with the very lowest rates performed the surgery in just 2.5% of vaginal births, on average.
As the National Institutes of Health (NIH) points out, an episiotomy comes with serious risks: There may be blood loss from the incision; the cut may tear further during delivery, damaging the muscle around the rectum or even the rectum itself; the cut and stitches may get infected afterward, and sex may be painful for a few months. Yikes! That said, sometimes an episiotomy is helpful, even with the risks—for example, if the baby's head or shoulders are too big for the mom's vaginal opening.
Talk to your doctor if you have concerns about how things will go during d-day. While there's no way to guarantee you'll get through labor episiotomy-free, the NIH recommends taking the following steps to lower your odds of needing the procedure:
Practice Your Kegels A toned pelvic floor makes labor easier, lowering the odds you'll need the surgical assist. To do a Kegel, squeeze and hold the vaginal muscles you use to stop the flow of urine for 10 seconds, then slowly release. (You shouldn't engage your glutes, stomach or inner thighs—just the pelvic floor muscles between your sit bones.) Do 20 10-second holds 5 times a day.
Try perineal massage The NIH recommends trying perineal massage during the 4 to 6 weeks before birth. The rationale: Kneading the area may soften the tissue, preventing tears. To try it, wash your hands thoroughly and rub a mild lubricant, such as K-Y jelly, on your thumbs. Place your thumbs inside your vagina and press downward on your rectum, holding for a minute or two. Then slowly massage the lower half of your vagina.
Remember best practices for breathing and pushing Those techniques you learned in childbirth class to control your breathing and your urge to bear down? Those are key, per the NIH: Controlling your breath helps you have a non-emergency delivery (one that's less likely to require an episiotomy), and resisting the urge to push like crazy too soon gives the area time to stretch out.