Dealing with an episiotomy: What to expect?

I was scrolling through some parenting forums recently, and honestly, it’s infuriating. You see these so-called "medical professionals" acting like routine episiotomies are just standard, unavoidable practice. When women come forward months later complaining about scarring, chronic pain, or other complications, these doctors just shrug it off with a dismissive, "Oh, that's perfectly normal."

How much longer are we supposed to tolerate this kind of incompetence? We have modern medical technology now, yet we're still dealing with practitioners who refuse to evolve and end up performing unnecessary procedures on women in labor. Why are we footing the bill for their outdated methods through our health insurance premiums? How do we actually hold them accountable? How do we stop this cycle?

you didn't really give me any actual counterarguments though—like, what happens if she just tears? (without any proper stitching, obviously)... you're left with wounds and scarring, and I'm guessing a hell of a lot of pain too

I honestly can't decide which is better—getting a routine episiotomy or just letting things happen "naturally"... I'd love to hear from someone who actually knows what they're talking about regarding this stuff.

rustymoose54 said:you didn't really offer any counterarguments: what happens if there's a tear (without proper stitches)? You're left with scars, wounds, and I assume, quite a bit of pain.

I honestly can't decide which is better—a routine episiotomy or just letting things happen "naturally." I'd love to hear from someone with more hands-on experience here.

Arguments? Fair enough. If you dig through some medical links or just do a quick Google search, you'll find roughly this:
- Tearing at the perineum during birth is actually quite rare. The body is incredibly elastic there, especially once those pregnancy hormones kick in.
- Most tears aren't catastrophic. They’re usually minor injuries that heal up just fine on their own, or maybe with one or two quick stitches.
- Tearing tends to happen more often when labor is being rushed. If things move at a slower pace, following the woman's rhythm, and if the perineum is supported and massaged properly, the chances of tearing drop significantly.
- Doing perineal massages during pregnancy can help increase tissue elasticity, which helps minimize the risk of tearing.
- Think of it like a piece of fabric. If you grab both ends and pull, it holds steady. But if you make a tiny snip in the middle and then pull? It rips right open. Human tissue works similarly: a cut acts as a stress point that encourages further tearing.
- Stitches can sometimes lead to further tearing that extends toward the anus, which can cause months of discomfort and complications.
- The idea that a clean incision heals better than a natural tear isn't necessarily true, especially if the stitching job itself isn't perfect.
- A tear might happen, but an incision is a guaranteed injury.
- In many cases, an episiotomy is unnecessary. It's better to prepare with massage and let labor progress naturally rather than cutting and dealing with the fallout.
- Unfortunately, much of the medical literature still frames the incision as a positive thing, but several clinical studies suggest otherwise. It seems like research findings don't always make it back into the textbooks—it takes forever in the medical world, probably a hundred years. Besides, if they don't perform the procedure, they have nothing to bill for.

Is that enough for you?

Justin Fox said:- tearing during childbirth is actually pretty rare—the body is super flexible there, especially thanks to those pregnancy hormones kicking in

The body isn't exactly "super flexible thanks to pregnancy hormones" 😁, trust me 😉... if there’s no actual tearing happening, then a routine episiotomy is just totally pointless.

Justin Fox said:- tearing usually isn't a huge deal; most small tears heal up just fine on their own or maybe with a stitch or two

I haven't been through it myself, but I know someone where things went south because they didn't have time to make a clean cut, so it was definitely not pretty. We're talking way beyond "small tears."

Justin Fox said:- tearing happens more often when labor is rushed—like, if things move too fast instead of letting the woman follow her own rhythm, or if you support and massage the perineum, the chances of tearing go down

Hm, what do you mean by "supporting" the perineum?

Justin Fox said:- doing perineal massages during pregnancy can help boost tissue elasticity and lower the risk of tearing
- think about a scrap of fabric—if you grab both ends and pull, it’s hard to rip. but if you nick it in the middle first and then pull? *rip*: it's the same thing with human tissue: a cut makes further tearing way more likely

Either it tears or it doesn't... it really just comes down to how much elasticity there is versus how big the baby is.

Justin Fox said:- cuts often lead to further tearing that goes toward the anus, which brings months of pain and issues
- the idea that a clean cut heals better than a tear doesn't always hold up, especially if the stitching is sloppy

If the stitching is bad, the woman is going to have problems regardless—whether they did a clean surgical cut or it was just a natural tear. But yeah, a clean cut is generally easier to sew back together. 😉 😁

Justin Fox said:- maybe it'll tear, you're definitely gonna end up with some damage
- honestly, cutting isn't even necessary most of the time: you're better off prepping with massage and just taking things slow rather than getting cut and dealing with the fallout later...

Look, if you want to claim that cutting is usually unnecessary, you'd need actual data from massive studies to back that up. Like, those studies would have to exist first, right? And when it comes to the whole speed and rhythm of labor... I'm afraid both you and I—just two theorists talking here—can't really have a competent debate about it.

Justin Fox said:- unfortunately, medical textbooks describe cutting as a good thing, but they're wrong. It's been proven in several clinical studies, but those results haven't made it back into the official literature yet. I guess in medicine, it takes like a hundred years for that to happen... besides, if they don't cut, they've got nothing to do and nothing to bill for.

Is this enough for you?

Wait, what do you mean by "results haven't made it back into the literature"? Are the studies not being published? Or are they just being ignored? And saying "if they don't cut, they've got nothing to charge for" is a total reach—it's definitely not a real argument. Most doctors have plenty to do during a delivery; the question is just how they choose to handle it. Plus, the paycheck is the same whether they perform a cut or just help support the perineum...😁

offtopik: rustymoose54, are you ignoring my DM on purpose, or did you just miss it because you were too distracted by all this beauty?

Jose Miller3 said:off-topic: rustymoose54, are you ghosting my DM on purpose, or did you just miss it because you were too busy staring at all this gorgeous stuff?

I honestly can't even tell anymore—my head is spinning from all these crazy colors, shapes, and patterns... it's just too much, man. totally wild.

I honestly believe routine episiotomies aren't just unnecessary—they’re actually harmful.

Look, if a baby is exceptionally large, there’s going to be some trauma regardless, and in those specific instances, maybe an incision makes sense. I can't say for sure.

But you can support the perineum manually; you can help guide the baby's head through

the process. A straight surgical cut might actually end up being deeper than a natural tear. I don't buy the argument that it’s easier to stitch up; it's just a clean line. If that cut goes deep into the muscle tissue, it’s arguably much worse than a superficial skin tear.

You have a point regarding our level of expertise here. I’m just offering my perspective, but I consider myself well-informed—perhaps even more so than certain doctors who haven't touched a piece of modern medical literature since they finished med school twenty years ago.

It seems to me that the medical establishment tends to ignore studies proving how damaging routine episiotomies can be. They ignore them because the system is notoriously slow to adopt new protocols.

I disagree with the idea that the doctor's involvement is neutral. If they perform the incision, they feel essential—they’re the center of the action. If they don't cut, they feel less needed. Some want to stay busy to maintain that sense of importance and, frankly, to ensure they get paid, since those procedures are billed heavily to Medicare.

Good grief. Reading this makes me want to just pack it in and quit entirely.😲

Anthony Rodriguez58 said:Good grief, reading through this—honestly, it makes me want to just call out sick and stay in bed.😲

Me neither. 😬

Ha, ha—yeah, right, they’re probably just cutting to make sure Medicare gets billed. Speaking of billing, I’ve been reading that at Holy Spirit, they can hand out TWO epidurals a day because Medicare stopped covering them. If it were truly about the money, we wouldn't be seeing all these routine episiotomies 😬

The real issue with episiotomies—and honestly, with pretty much any medical intervention during labor—is how incredibly routine they’ve become. Around here, births seem to happen on some kind of assembly line; everything is rushed through, which is definitely not ideal. That said, I am seeing more stories lately where women, even first-timers, managed to avoid an episiotomy altogether, so there might actually be some progress happening after all.

Whether it’s better to tear naturally or to be cut is something I really can't say for certain; the absolute best-case scenario, obviously, is avoiding both tearing and cutting entirely.

I won't get too deep into the details here, but honestly? I’d sign anything just to make sure my coverage doesn't get cut. I'm just hoping they can find some decent midwife out there to help look after things...

..maybe we should just let Justin Fox deliver the baby—the guy actually knows what he's talking about for once 😁

Come here, Justin Fox, honey, please just trade places with me. I’m sitting here with 17 stitches because I tore so badly, and my baby is barely the size of a little chick—maybe a pound or something. I’m 7 and a half months along with my second, and honestly? I would give anything for just a routine checkup and those few simple stitches I had after my first baby.

Grace Jackson11 said:Oh, come here, Justin Fox, please—let’s trade places. I ended up with seventeen stitches because I tore so badly, and the baby was tiny, barely even a pound or two. I was only seven and a half months along with my second child. Believe me, I would give anything for just one routine delivery and those few simple stitches I had after my first one.

It sounds like you went through a nightmare. Being seven and a half months along feels like a premature delivery; was it an emergency situation where things just moved too fast? Did you do any prep work, like prenatal massage? And how did you feel after your first birth, where you mentioned having an episiotomy (if I'm reading you right)?

Look, I’m definitely not an OB/GYN, but I actually know a decent amount about tissue structure and elasticity, so I just wanted to weigh in on a few things here:
- Some people just have tissue that tears regardless of how much massage, creams, or intensive care they use. It really comes down to your levels of elastin and collagen—basically genetic factors you can't control. It’s just like stretch marks during pregnancy; you see some women who apply lotion twenty times a day and still get them, while others don't even bother and stay perfectly smooth.
- There’s this misconception that a natural tear is somehow "better" or less damaging than a surgical episiotomy. That’s just not true. If a woman suffers a significant tear that reaches the anal sphincter, she could end up dealing with incontinence for the rest of her life.
- Also, the idea that doctors perform episiotomies just because Medicare makes it profitable is a myth. In the US, the cost of delivery is bundled into one flat rate that covers everything from the pre-delivery meds to the postpartum care and any necessary repairs. They aren't getting a separate payday for choosing one over the other.

I could probably go on more, but I'll leave it at that... 😬

You say it tears, but honestly, it’s just whoever has bad luck whose tissue gives way. Besides, third and fourth-degree tears can still happen even after a medial episiotomy, right? Do you actually have statistics showing that massage helps? Do you agree that most people find relief from it? Personally, I think some folks definitely need the incision, but it shouldn't be treated as standard procedure for everyone.

Check out this article:
http://www.efn.org/~djz/birth/obmyth/epis.html
Right at the start, it says: "There is no evidence . . . that routine episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents fetal trauma or reduces the risk of urinary stress incontinence." Sleep, Roberts, and Chalmers 1989

Bromberg MH writes in "Presumptive maternal benefits of routine episiotomy. J Nurse Midwifery 1986;31(3):121-127" that: "What little evidence exists in favor of episiotomy is over 60 years old and of poor methodology...some studies show an association between episiotomy and deep tears"

Take a look at this diagram for third-degree tears:
http://catalog.nucleusinc.com/enlarg...t.php?ID=10808
To me, a medial cut looks like an invitation for a tear. If things are going to rip, the incision just makes it go deeper.

Here is a photo of a mediolateral incision in vivo. Does this look like a bright idea to you?
http://www.sciencebasedbirth.com/Ima...2003/epis2.jpg
It looks like damage that will cause months of pain, infection, scarring, and maybe never fully heal. It could lead to lifelong discomfort during sex or even just sitting down—interfering with someone's life and career. In a word: a disaster.
Emotionally speaking, I would rather not have children at all than see someone I love go through that. A cut like that should never be performed by a doctor without explicit consent from the patient.

Justin Fox said:You say it just snaps—basically, whoever is unlucky enough just has their tissue tear. But 3rd and 4th-degree tears can happen during a medial episiotomy too, right? Do you actually have stats showing massage helps? Do you agree most people find relief from it? I guess I agree some need a cut, but certainly not everyone, and definitely not as a standard routine.

Check out this article:
http://www.efn.org/~djz/birth/obmyth/epis.html
Right at the start, it says: "There is no evidence . . . that routine episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents fetal trauma or reduces the risk of urinary stress incontinence." Sleep, Roberts, and Chalmers 1989

Bromberg MH. Presumptive maternal benefits of routine episiotomy. J Nurse Midwifery 1986;31(3):121-127 says: "What little evidence exists in favor of episiotomy is over 60 years old and of poor methodology...some studies show an association between episiotomy and deep tears"

Look at this diagram for a 3rd-degree tear:
http://catalog.nucleusinc.com/enlarg...t.php?ID=10808
To me, it looks like a medial incision is just an invitation for a tear—like, if things are going to rip, the cut just makes them rip deeper.

Here’s a photo of a mediolateral incision in vivo. Does this look like a great idea to you?
http://www.sciencebasedbirth.com/Ima...2003/epis2.jpg
It looks like damage that’ll hurt for months, get infected, leave scars, maybe never fully heal, and maybe even cause pain during sex forever. It could make sitting painful, interfere with life and career... basically, a disaster.
Emotionally speaking: I’d honestly rather not have kids than let someone do that to a loved one. I wouldn't allow a doctor to make a cut like that without explicit consent from the patient.

Fine, then there's nothing left to do but deliver via C-section. ☕

Justin Fox said:So, you had a really bad experience. 7.5 months sounds like it was premature—was it rushed because it was an emergency? Did you prepare at all? Like, did you do any massage work? And how did you feel after your first birth where you mentioned having an episiotomy (if I'm understanding you right)?

Justin Fox, are you maybe a man?😬

My first birth... let's just say things went smooth, and I never even felt the scar. Maybe it wasn't strictly necessary, but it didn't cause harm either (that’s my whole point!). My second birth, though... that was premature. You don't need a PhD to figure that one out, it was just rushed...
It seems like you think a cut is just an invitation for tearing. I don't see it that way, because with my first baby—who was normally large after the incision—I didn't tear even a millimeter. But with the second one, without the incision, I ended up with 17 stitches and scars that I definitely still feel.
The incision wound healed almost immediately, but the tearing wound? That hurt for weeks. I couldn't sit down; I had to pee standing up... and through different phases of my hormonal cycle, I can still feel that scar "acting up," even now, 11 years later.
Just ask my husband if he'd want them to "do that" to his darling wife.
To go back to the beginning, episiotomies are done routinely specifically so that what happened to me doesn't happen. It makes delivery easier for everyone. Maybe, with better hospital organization, more midwives and doctors, a more personalized approach, and all that, they could avoid the routine and only do it when actually needed. But with how things are set up for us right now, I guess it's better to do it routinely for everyone than to not do it at all.
And one more thing... about those massages that are supposed to help... for your darling wife...

Grace Jackson11 said:Justin Fox, are you actually a guy?

Yes, I’m a man. Isn't that fairly obvious from my previous posts?

Grace Jackson11 said:It seems like you think an episiotomy is just setting the stage for tearing. I have to disagree. With my first baby—who was quite large, by the way—I had an incision, yet I didn't tear a single millimeter. Then, with my second, we skipped the incision entirely, and I ended up needing seventeen stitches and dealing with scars that I can still feel today. Experience is a funny thing, isn't it?

I’m not saying that an incision necessarily leads to tearing, but I do think it can make the tearing much worse. In your case, it's possible those initial cuts were totally unnecessary, though I am encouraged to hear you didn't suffer any lasting damage—that suggests an episiotomy doesn't always result in permanent injury. Still, just because your first experience was a positive one doesn't mean every cut goes smoothly. I've seen plenty of people deal with exactly the kind of issues you're describing specifically after an episiotomy.

In that second case, if things tore that badly, something clearly went sideways. Honestly, who’s to say if an episiotomy would have actually helped you? To me, it sounds like the tissue just wasn't ready—like the hormones hadn't quite done their job yet to prep everything. But your situation is different because you were dealing with a preterm labor, which is a whole different ballgame entirely. Looking back, do you think they should have just gone straight to a C-section? And I have to ask—did you end up filing any kind of lawsuit against the hospital or the doctor who handled your delivery?

Grace Jackson11 said:The incision from the surgery healed almost instantly. But that gunshot wound? That was a different story entirely. It hurt for weeks. I couldn't sit down for anything, so I ended up having to pee standing up just to get through it. Even now, eleven years later, I can still feel the scar "acting up" depending on where I am in my hormonal cycle. It’s strange how the body remembers.

Could you walk me through how that scar feels now, even after eleven years? I'm curious about when you hit that peak period of healing—was it around the two-year mark? Does it actually get in the way of your day-to-day life, or does it still cause you any real pain? Also, did you ever try any specific treatments for it? If so, what kind of methods did you go with?

Grace Jackson11 said:Ask my husband if he’d want to do that to his "dear wife."

I’d honestly rather ask him—just like I’d ask you—what exactly you did once that injury was inflicted. Did you actually make some noise about it, or did you just quietly take it on the chin?

Grace Jackson11 said:Let’s go back to basics here. An episiotomy is performed routinely specifically to prevent exactly what I went through. It just makes the whole delivery process smoother for everyone involved.

I couldn't disagree more. Your situation was a case of preterm labor, which changes the math entirely. Most medical studies actually contradict what you’re saying here. I get that you're hurting and dealing with an injury—that's heavy, and I'm sorry—but I really don't think an episiotomy would have changed the outcome for you. Don't you agree that we should let every woman decide what’s best for her own body? Wouldn't it be better if every expectant mother was fully briefed on the situation? We should show them the clinical photos, lay out the potential consequences objectively without pushing them toward or away from an episiotomy, and then just let them make the call during a standard delivery—based on the doctor's assessment, of course. It should be their choice.

Grace Jackson11 said:Given the way things are currently set up, I’d say routine procedures for everyone are better than doing nothing at all.

Absolutely not. You simply cannot take one single instance of preterm labor and use it as the foundation for an argument like that. 😠🙂

Grace Jackson11 said:And one more thing, those massages that are supposed to help you... for your dear...

I truly hope you're mistaken here. It feels less like you're trying to grasp the actual issue and more like you're judging based on a personal misfortune—which, for what it's worth, I am sorry you had to endure—but you're conflating two completely different things. Personally, as a man, I’d much rather undergo a massage several times over a procedure like cervical ripening. What if the massage doesn't work? Nothing happens. It isn't painful, it isn't invasive, and it certainly doesn't cause injury. If it does work? Then it's a win, and she avoids the complications you dealt with.

Thanks for sharing your own experience; I think it provides some useful context for everyone else reading this thread.

No, the thing is, it really bugs me when people try to label something as just pure butchery based on nothing but a few studies.
I definitely agree, though, that both my own experiences and your posts are super helpful for everyone here.