Are Episiotomies Necessary? {Ask the Readers}

I’ve never had one, so maybe some of my fabulous readers can help MaryAnn out with this question:

I’ve seen a little bit about episiotomies and the entire idea kind of freaks me out.  Is it required?  Is it preventable?  Is it really as awful as it sounds?  I’ve seen a little bit about preventing one, but then some articles that say that there are hospitals that will require you to get one. What’s the deal?

I have no medical or midwife training whatsoever, and can only answer based on experience and information from our own natural birth classes.   From what I understand, routine episiotomies are a thing of the past.  (My mom had them when she delivered us.)  In our childbirth classes, we learned that a natural tear is easier to stitch and heals better and faster than a cut.

Is it required?  I sure hope not!  Truly, it seems senseless (and dangerous!) to cut without good reason.  A careful doctor or midwife will help the mom control her pushing and stretch the perineal area.  Could you still tear?  Yep.  I did, three different times.  Do I regret not having an episiotomy?  Not a bit!

I would recommend talking with your doctor or midwife about the requirements at your particular hospital.  If your doctor does routine episiotomies, be sure ask about the reasoning behind that decision, and don’t be afraid to refuse the procedure.  This is exactly the kind of issue that makes me passionate about writing out a birth plan, too, to share and discuss with the doctor ahead of time.  “Let’s just see how it goes” doesn’t fly with me when it comes to things like cutting.  Ouch!

Again, I’m not a doctor and have no personal experience with an episiotomy.  My guess is that, much like a c-section, they are necessary in some circumstances.  If you’ve had one, do tell!  Helpful?  Necessary?  Routine? 


  1. I’ve done both ways. I tore once after less than 10 minutes of pushing and I’ve had an episiotomy after over 2 hours of pushing. I can honestly say I’d prefer the episiotomy. I bounce back from delivery fairly easily, but I was in a lot more pain after tearing. I make it a point now to let the midwife know that I prefer the episiotomy, but only in the event that I’m actually starting to tear. If my body’s already going to do it, I know that I prefer to heal from a straight cut than what can be a fairly jagged tear. I think it’s all about personal preference though and unfortunately, you have to go through it to know what it feels like!

  2. I had a difficult birth- narrow pelvis and an unexpectedly large (9 lb 7 oz) child. (The dr estimated 7 lbs at most from my measurements and ultrasound. Fun surprise- not!) My son also had shoulder dystocia, which basically means: he was stuck. It was too late to c-section. His shoulder was bent back behind him and there was possibility of nerve and muscle damage for him, and increased risk of tearing and hemorrage for me. I had a stage 3 tear which was difficult to stitch back together. There was no way to prevent tearing in my situation unless I had an episiotomy, which I did not. It was lumpy and I still experience occasional pain with the scar site 14 months later. From what I have read, this is not terribly uncommon with tear sites, and is not at all common in episiotomies.

    • Your situation sounds very similar to mine with the shoulder dystocia, except my baby was a little bigger and I did get an episiotomy. Thankfully, my doctor had the sense to cut me (on both sides) even though she doesn’t normally do episiotomies. She saw that things were going badly, and made the decision to cut, and because of that I believe that I was spared a worse tear. I still got a third degree tear, but I didn’t quite tear all of the way through. I’ve had six children, with six very different delivery experiences and the most important piece of advice I can give is FIND A DOCTOR THAT YOU CAN TRUST. Notice I didn’t say trust your doctor, because I had a doctor who wasn’t concerned about my well being for my first delivery. It was quite a learning experience. I finally found a doctor that put their patients first (prayed often for us, allowed me to have a vaginal birth after 2 cesareans, etc) and trusted their judgement when I found myself in a situation in which a decision needed to be made quickly regarding whether to do an episiotomy. I think sometimes episiotomies are necessary, but most of the time they are not. That being said, it was WAY easier to recover from an episiotomy than it was to recover from a tear! 🙂

    • Ouch! And the shoulder dystocia sounds scary.

  3. I also have had both, episiotomy and tearing. I agree with Shandra above, that the episiotomy was preferable. I tore in two places and they took quite a while to heal. I also had issues with scar tissue after the tearing. I barely noticed the episiotomy, and it healed quite quickly. I remember being so freaked out about needing one with my first baby, as every pregnancy book I read said it was such an awful procedure. But, after it was done, I realized it really wasn’t bad at all.

  4. I had one with my older son (now age 35) – a routine thing at the time. It was a month before I could even make the bed without pain, and walking to the corner grocery was a dream for the future. My second son I had natural, and he was a big boy. I tore, but was up and around the same day I had him. If given the choice, I would NEVER have the episiotomy again!

  5. Here’s my two cents. I had one with my daughter & I do not regret it. Would I take an episotomy over a c-section? Absolutely. I pushed for 45 minutes. I think my daughter’s heartbeat started to dip and maybe she was almost getting stuck. They cut me and used a vaccum. The nice thing was that they numbed me so I never felt the ring of fire. However, I was in a lot of pain after because I had a third degree tear, which they say is about as bad as a c section, pain wise. I’m thankful I didn’t have a csection because they still claim I had a normal delivery and therefore will absolutely let me have a vaginal birth again. I do think they are preventable, I just really had no idea how to push & (maybe) my baby was too big but I don’t regret getting one.

    • I had no idea how to push with my first, either, and ended up pushing for 4 hours or something stupid. My problem was that I never felt the overwhelming URGE to push.

  6. Episiotomies are almost NEVER necessary, but they are an obstetrical dinosaur that refuses to die. Supporting the perineum in other ways – by using spontaneous instead of coached/forced pushing, using better pushing positions than the lithotomy, laboring in water, etc., will usually prevent tearing (or major tearing), and tears, when they occur, will heal easily and less painfully than an episiotomy. If your hospital or doctor requires one (or seems like he will), then find a new doctor NOW – or a midwife. All the more so because a doctor who still requires routine episiotomies is likely to be stuck in other bad practices as well (like immediate cord clamping, for example). Additionally, refusing in the moment (i.e. “My doctor does routine episiotomies, but I’ll just refuse”) is not a great idea because you’ll be too busy in the moment (usually) to think about it, and wishes aren’t always honored when the mum isn’t looking. Do not stick with a doctor who practices routine episiotomy.

    • “by using spontaneous instead of coached/forced pushing, using better pushing positions” Ah, yes. I think part of my “success” with my last baby was that my body was pushing for about an hour before I had to bear down and tell the nurse. 😉 I just sat on the toilet and let my body do its thing.

  7. I’m firmly against episotomies. When I was nursing, we were told the main reasoning for most episotomies was to make it easier and quicker for the OB/GYN or midwives to deliver and sew up any tears .

    The body has amazing stretching properties. This is how women’s bodies were designed. If a labor advances at a natural rate, without drug accelerants, the body should naturally stretch to accomodate for the birth. Also, natural tears, although a little more difficult to sew up, heal quicker and leave less scarring. As the edges aren’t linear, they intermesh making the scarring less prone to tearing for further pregnancies and the scarring less noticiable.

    I have seen doctors perform an episotomies and then use suction to hurry the baby’s delivery so that they could get it over with. Really! One memorable time was the doctor’s baseball team had a game on and didn’t want to wait for the labor to progress at as natural rate as he would most likely miss his game. Nice guy, not! He gave this poor woman an unnecessary procedure and pain to make his life easier.

    • Yuck. That’s just WRONG (hurry up for the game). I am glad, however, that the procedure is available when needed… I just don’t think all docs view “need” the same way. 😉

  8. I had a natural, mid-wife attended hospital birth but did have an episiotomy. I knew our midwives would only cut if absolutely necessary. After pushing for hours and not getting his head out, our midwife made a very small cut. Wesley was out after the next contraction. I am confident that our midwife did what was necessary to get our baby out. I fear that had we birthed with an ob even more measures would have been used to get our boy out. It wasn’t pleasant – I tore also – but I am confident it was necessary in this case.

    • Same thing happened to me. After 2 1/2 hours of pushing, my midwife did an episiotomy and my son came out on the next push. She knew it was best in that situation. Each birth is so different. I was at a birthing center (natural childbirth) and am grateful for the wisdom of my midwife.

    • It’s so reassuring to have that confidence in the midwife, too.

  9. The hospital where I have delivered and my doctor both do not do episiotomies routinely. As my doctor explained it, “Why would I introduce an opportunity for infection unless necessary?” That noted, she also went on to explain that while a women is in delivery, the doctor has 2 patients, mother and baby and she always side with the baby’s best interest. I appreciated her telling me she would choose the best thing for my baby (even if it meant extra pain for me). 🙂 If an episiotomy was best for the baby, then that is what would be done. Both times I tore fairly badly and that was a difficult part of both immediate post-delivery and at home recovery, but I can’t argue for tearing being better or worse than an episiotomy. I’m not sure if that helps, but I find having a “baby first” attitude makes it easier to consider having an episiotomy.

  10. I had an episiotomy with my first born, and I also tore in two different directions. My recovery following her delivery was longer and harder than my other three children. With my other three, I had slight tears, all along the scar tissue from the episiotomy. I’m very much along the side of tearing versus being cut. I agree that my OB did the episiotomy to speed things up where my midwife with the other three did more work to stretch the perineum and give my body time. All deliveries were natural and the recovery from the tears was way easier than the episiotomy.

    • Thanks for chiming in with your perspective! I didn’t tear with my last two and my doc said it was because my body had time to stretch. (I know time isn’t always a luxury, though.)

  11. I used a midwife for the deliveries of both of my sons, and in both cases I ended up having an episiotomy. They were both painful, the first one was worse than the second. However, in both cases I had an episiotomy done because the baby’s heart rate was dropping (probably because of the intense pitocin-induced contractions). I know a drop in heart rate can sometimes result in the need for an emergency c-section, so I think getting cut was preferable to a c-section. I believe both midwives made the best choice for the baby’s safe delivery, and they they only did it because it really was necessary. It is definitely not standard practice for them.

  12. Since I’ve been on the receiving end of very thoughtless (and heartless) “there’s never a need for that” comments, I’d never make that suggestion about another woman’s birth experience. That said, I happened to have a doctor who was of the mindset that tears typically heal just as well as cuts and, furthermore, some women don’t tear at all or at least not as much as they might be cut in an episiotomy. So. That was my experience. I had a pretty bad tear (there was some debate over whether it was 3rd or 4th degree but, really, it’s not a competition…) with my first baby. It required gazillions of stitches, it seemed, but I healed just fine from it. I have also had c-sections and, for me, the pain of tearing was not even in the same ballpark as c-s recovery. I chalk this up to one being, no matter how uncomfortable, a pretty natural thing, and the other being absolutely surgical intervention.

  13. My midwife and doctor said that when you tear, the tear goes along the nerve cell walls (instead of right through them with a cut) and so it’s easier for the body to heal from a tear. They also said tears can be harder to stitch, but easier to heal from, so they’re preferable. Sounds like there are about as many opinions as there are practitioners, though! 🙂

    I tore (3rd, almost 4th degree) with my little guy, and the pain definitely stuck around for awhile. I still get twinges, 9 months later. I agree with the idea of finding a doctor/midwife you can trust, and letting him/her know of your wishes before the birth. I had no presence of mind during final stages of labor to say anything that I meant to 🙂

  14. I know my situation was uncommon, but I think it was one in which allowing an episiotomy allowed me to have an otherwise natural, intervention free hospital birth. The issue was that my son was presenting frank breech. We knew this going into the situation and were well prepared, and I pushed several times before the OB decided to recommend an episiotomy. I otherwise would have chosen to have a natural tear, but in this case I am glad I had an episiotomy as we wanted to avoid any kind of stalling in the pushing stage if I was going to avoid a surgical delivery. It was one of those battles I chose not to fight given the rare circumstances. I was fortunate enough to connect with a doctor that would attempt that type of delivery. Again, I know this is an uncommon case, but living through it showed me that there are exceptional cases in which episiotomies may be recommended.

  15. How you approach labor is completely up to you. If you want to tear naturally tell your Dr. and the nurses working with you and you should be fine.
    I had to have and episiotomy last minute because my daughter was sunny side up, stuck, and started to get distressed. I ended up with second degree tearing from pushing for 2+ hours and the procedure. While it hurt it was nothing compared to the hemorrhoids I got from pushing for so long. Plus I would take the episiotomy over having a c-section which I was being prepped for if the Dr couldn’t get baby out and fast, which the episiotomy allowed for. Do I hope to have one ever again? No. But it did help me get my baby here healthy and helped me to avoid a c-section. Overall it really wasn’t too bad.

  16. I’m 21 weeks pregnant with my first and really enjoy reading these kinds of posts, Amy!

    My husband and I were talking last night about my doctor (a family dr.) and based on our 20 week visit, neither of us were too impressed. She didn’t seem to know anything about me, even though I’ve been seeing her for 2 years. Just was very disconnected, which concerns me.

    Maybe you have a post in the works about this, but here’s a question that I could use some advice on: What questions should I ask my doctor during pregnancy? Some of my thoughts are episiotomies, cutting/clamping the cord (when), induction, c-section rates,…but I’m sure there are more. I know I would benefit greatly from hearing other women share their opinions about this! Thank you 🙂

    • I’ve had three babies, with three doctors, at three different hospitals. (We’re military, so we get around!)

      With my second, I had doubts about my doctor from my very first visit when his nurse told me “Don’t worry, he won’t let you go past your due date.” Some women probably appreciate this, but I wanted a natural childbirth experience and the fact that they were already ready to induce me was troublesome.

      Still, I didn’t want to be stereotyped as a overly sensitive pregnant pain-in-the-butt, so I just kept believing things would get better, even when other things my doctor said and did made me less and less comfortable with him.

      In the end, it was by far my most unpleasant delivery experience. My doctor and I were just not on the same page. I can’t only blame him for the bad experience though; I should have trusted my gut and found a doctor I was more compatible with.

      My advice is that if you are having doubts about your practitioner at the very least ask around and get the names of some other doctors in your area to check out. You may find one that you mesh better with, or you may find that your current doctor was just having a bad day.

      • Thanks for the advice, Karen; I really appreciate it. My dr. is part of a clinic, which has several other doctors (plus a midwife, who I’ve not met). So we have some options to check into.

        We know she was on hospital duty that day AND there was a terrible car accident that AM (with a fatality), so we think she could have been involved with that at the local hospital before she saw us. So it is possible that it was just a bad day. We both sorta agreed we would see how our 24 week appt. goes, based on that. But I like what you said about going with our gut and not just expecting things to go the way I expect them to. Thank you!

    • Jana Brown says:

      I HIGHLY HIGHLY recommend 2 books: Ina May Gaskins Guide to Childbirth and Dr Robert Bradley’s Husband-coached Childbirth.

      I gave birth to my 5 yr old twin boys vaginally, in a hospital, induced, w/ an epidural and an episiotomy. I just gave birth to my new little boy 6 weeks ago and it was a complete opposite experience. I wish I had done my research and asked questions and read books while pregnant with my twins. I had quite a bit of scar tissue from the episiotomy that made “things” VERY painful for well over a year. I had my newest son at home, in the water, and basically ripped my scar back open. My son was 9 lbs (my twins were both about 6 lbs). But it has healed so much faster than my episiotomy and my recovery has been almost nonexistent. My most recent birthing experience was simply amazing and I wouldn’t change a thing about it.

      • Jana Brown says:

        Also, you still have plenty of time to take Bradley’s Childbirth class. It was an awesome resource and I would recommend it to anyone no matter their preferences during labor/delivery.

    • I’ll add that question to my post drafts. Good one!

  17. I had one with my first one and I believe it was unneccessary, but routine. I ended up tearing all the way through and it took forever to heal and was very painful.

    My second birth I adamantly refused an episiotomy. When I pushed the baby’s heart rate dropped the dr frantically said she had to do one. I was screaming no while she was cutting and a second later the baby was born. I’m not sure it was needed then either and I was not happy about it! But nothing I could do. I didn’t have one, but tore, with my last 2.

  18. Similar to a couple others who already commented, I had a very large (9+ lb) baby, whose head was out and the rest of him was stuck. In that situation, you don’t really care what your plan was or the pain you’ll be in, you just want your baby to come out and be okay. It seems absurd to me that there are actually doctors/hospitals that require one. But in that situation I was very thankful that it helped my baby to be born healthy.

  19. During one of my child development classes the teacher very randomly told us to never have one done. (we were talking about babies but not birth or anything and it has always stuck with me.) She explained that if you cut a piece of paper it tears more easily than if you just tear it, which makes since. I tore very severly with my 7lb premie, and I also tore and required one stitch with my 3lb premie. But I didn’t have an episiotomy done either time.

    • I’m not a big fan of “never” because someone will always have a situation that will prove me wrong, but yes. That was the reasoning we were taught, too.

  20. I had an episiotomy with my first, and I didn’t know it was happening. I am 100% positive it was because they were trying to get the baby out as fast as possible (my first, and I only pushed about 20 minutes total). They used the vacuum on her, too.

    With my second, I had a natural birth and tore extremely badly because it was SUPER DUPER quick and my kid has a giant head. The sewing up was much more painful than with the epis. because I didn’t have the epidural, either.

    Both hurt like crazy for a long time afterward and required a lot of care. But at least I knew what was going on in my second birth and OKed it.

  21. First, it’s so fun and ineresting to read all of these comments. 🙂
    My sister, who is 12 years older than me and had 4 babies before I had my first, had taught me a lot about natural childbirth while I was pregnant with my first. I was 19 so I really trusted her. She was in the delivery room when I was in labor. My labor progressed very quickly and at one point I was even rushed out to have a c section because my son’s heart rate kept dropping. Thankfully my midwife was wise enough to help me avoid that, but she did want me to start pushing even though I wasn’t quite to 10 cm yet. She started to say that I was going to need an episiotomy. I remember saying no, but then my sister (who was definitely NOT pro episiotomy!) calmly told me that if that’s what was best then it would be ok. And it was. That was my only episiotomy out of 4 vaginal births (my last was a c section). I tore mildly with the others but nothing major…even having my second son in the car with only firemen there to deliver! 🙂

  22. Deborah Jennings says:

    I had to have an episiotomie with all 3 of my children. I have a small pelvis area, and was told with the first baby that I was so small that I might have to have a C-section. Luckily she only weighed 7 – 5/1/2! And that was my biggest baby. I didn’t have any trouble with mine. The best feeling ever was to sit in the sitz bath. (Warm water.) It felt wonderful! Some doctor’s use some kind of light, but the sitz bath was the best to me! You can even do that when you get home, but don’t use any soap or anything but warm water in the tub. Lay back and relax. =) OK this was 44 years ago, but who’s counting?

  23. I’ve birthed 5 babies and have had an episiotomy with 2 of them. With my first baby, I had an epidural and could not at all feel what I was doing. After 2 hours of pushing I was given a 3rd degree episiotomy and vaccum delivery. It was terrible and I was in so much pain. The second time around, I knew I didn’t want that, and did not have an epidural but I did end up with a smaller episiotomy because my sons heartrate kept dipping and they wanted him out ASAP. It was not as bad though. The nurse said that I was stretching just fine and had his heartrate not dipped so many times I would not have needed one. And sure enough, the next 3 babies I delivered without an episiotomy OR tears! Our bodies, when left to do what is natrual, can accomplish amazing things. But I do beleive that sometimes, in the case of my second child, an episiotomy is necessary. he was a big boy (9#110z) and the cord was tightly wrapped around his neck and each time I pushed, it was being compressed so the extra time it took to push without the episiotomy might have been very bad for him.

    • “Our bodies, when left to do what is natrual, can accomplish amazing things. But I do beleive that sometimes, in the case of my second child, an episiotomy is necessary.” Yes. Yes. and Yes! 🙂

  24. As I was preparing for my first labor, I knew I didn’t want an episiotomy because the rationale of it’s better to tear naturally and there’s no real reason for them made sense to me. However, after 2 hours of (unmedicated) pushing and hearing “he’s RIGHT there! just a few more pushes!” the whole time, I was exhausted and completely done. I basically gave up and said “I need help”. My dr. said if I wanted, she could do an episiotomy. I said “please” and very shortly after my son was born. I’m sure it could have been avoided and I could tell my dr. didn’t even think it was necessary but in the end I had no regrets. All in all it was a very uncomplicated, calm labor and delivery even if getting cut was not in my plan. Now, I would be wary of a dr. who did them routinely, that seems pretty old fashioned! Oh, and I was very sore for a couple of weeks, did not have that “I feel great!” feeling that I had always heard was associated with an unmedicated birth. No problems after the initial healing, though.

    • I love your attitude. 🙂 It’s good to have a plan, and it’s good to know when the plan isn’t working well and keep everyone safe.

  25. I remember both my doula (who is also a CPM) and my OB saying a couple of helpful things about tears/episiotomies. My doula suggested stretching the perineum regularly before labor even begins–just for a few minutes each night, starting at about week 37. And my OB mentioned that there are situations where a natural tear would go UP, not down; these types of tears can end up permanently impairing sexual function, so she does episiotomies to avoid them. Otherwise, however, she said she almost always prefers to let her patients tear because (in her opinion/experience) tears heal more easily and cause fewer problems down the road.

    I tore somewhat with my daughter and had to have quite a few stitches, largely because an early birth and emergency induction prevented me from doing all the preferred stretching exercises. For a couple of days, I felt like I’d been hit by a truck, but then I bounced right back. I did have some scar tissue that formed, but my OB was able to remove it quickly and relatively painlessly with cauterization. I’ve never had an episiotomy, so I can’t compare the two.

  26. My mother and I had the same doctor deliver all of our babies, and he does routine episiotomies. (He does ask though before he cuts! He’s actually retiring this fall, so he’s been delivering babies for more than 30 years. He’s a good guy, and a good listener.) My mother had 6 episiotomies, and I had 2 episiotomies. She didn’t seem to mind, so I didn’t think it was a big deal either. I had a lot of pain after my first child (8lb9oz, 7 days overdue), but was up and about right after the second (9lb10oz, 12 days overdue). I guess I just chalked the pain up to being a first-timer. Both of my children were born after less than 4 hours of contractions at home, and after less than an hour in delivery at the hospital. Both births were so fast (despite being big, overdue babies), vaginal, and drug-free, so I didn’t see any reason to complain. I was glad that I hadn’t needed a C-section or anything else.

    • Yes. I think “back in the day” it was routine, and it sounds like your doc’s been around for awhile. 😉 I like what another commenter said (quote from her doctor) though, “Why risk infection if we don’t need to?”

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