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Ask A Childbirth Educator
Questions and Answer

Q. I am second year nursing student, and we are currently studying the laboring woman. It came up that someone had heard that natural tearing will heal better than an episiotomy, and also has some other benefits. Can you verify this statement, and provide some pros and cons to each alternative? >>

A. Most certainly.

Studies done in the last five years have been showing that women who spontaneously tear tend to heal faster, have less pain, and better pelvic floor strength postpartum than women who have episiotomies. They also tend to have fewer third and fourth degree tears (tears that go to or into rectum) than women who have episiotomies.

Techniques such as perineal support, perineal massage, use of warm compresses and oil, as well as more upright birthing positions reduce a woman's chance of tearing as well.

Episiotomy is a useful procedure in certain situations where getting the baby out five minutes faster can make a crucial difference. Shoulder dystocia (stuck shoulders) is one of these; some practitioners feel that an episiotomy allows the caregiver to better release the baby. It may also be needed for instrument deliveries such as forceps and vacuum extraction, where the episiotomy makes room for the instrument to be inserted. However, the research just does not bear out the idea that a woman is benefitted by having an episiotomy during a normal vaginal birth.

Some caregivers feel that it is easier to repair a straight cut than a jagged tear. Some feel it is the opposite. In truth, many women who are not given an episiotomy and are being attended by a caregiver who knows how to ease the baby out, will not tear at all.

Mothers can also help avoid tearing by panting or blowing at the moment of crowning (when they feel the burn). Blowing keeps them from pushing hard and rushing the baby against the perineum. The baby's head will slowly stretch the perineum and come through on its own. I recommend the films Birth Reborn and also Birth in the Squatting Position for those interested in seeing babies born spontaneously without an episiotomy.

Karen Klimsak-Ungar, CCE has been a certified childbirth educator for Birth Works® since 1996. She is currently Managing Editor for the Birth Works newsletter, sits on the Birth Works Board of Directors, and serves on their National Trainee Review Committee. A happily married mother of two, she also continues to teach Birth Works classes as well as private classes.

Karen will answer your questions on fertility, pregnancy, birth, breastfeeding and babies. Her advice does not take the place of your practitioner. Personal answers will not always be possible.