Dealing with an episiotomy: What to expect?

I'm back, my lunch was boiling over.
So, look, I’m not advocating for routine episiotomies, or any procedure just for the sake of doing it. I was just trying to explain that it doesn't have to be "butchery." My situation is just one case—well, two—so I'm not generalizing based on that. What actually got you interested in this issue? What’s your experience been like? Were you actually in the delivery room? Do you know what led to episiotomies being introduced into medical practice in the first place? And honestly, do our hospitals even have enough resources—like staffing, beds, equipment—to allow for a more individualized approach?
I'm not sure if a woman should always get to decide exactly what she wants, but she absolutely needs to be consulted. You have to explain the procedure, the reasons behind it, and the consequences—absolutely. And that applies everywhere, not just at the maternity ward.
I agree that you need to prepare your body with massages, exercises, and creams, I just wanted to say that sometimes that isn't enough. Okay, fine, you got under my skin, so I snapped at you a little. I've worked with my body my whole life; I did special prenatal exercises, used all the creams... Even if my first incision was unnecessary, it didn't hurt me!
And regarding bringing up studies... we had those studies about the link between MMR and autism, and studies about iron levels in spinach...
I really value how much effort you're putting in and your interest in this topic; I think it's incredibly important and informative. It's just that your aggressive tone and how stubbornly you stick to one single thesis bothered me. Maybe if you had framed things differently... maybe if you judged a poorly executed cut that led to tearing, or an unnecessary one that left a scar interfering with daily life...
As for your other questions, we haven't sued anyone. We would sue in cases of permanent disability, or if someone couldn't perform daily functions, etc., but we did loudly demand explanations for everything. In the end, my experience was positive; I got the answers I was looking for, and I accepted them.
To all the future moms we might have stressed out—wishing you so much happiness. It really isn't even half as scary as it seems from the posts by Justin Fox and myself, and that little bit of discomfort is worth a million stitches and scars.

Grace Jackson11, I’m honestly relieved we managed to steer this whole argument toward something actually productive. 🙂 I think we can all agree that a personalized approach is non-negotiable here. As for the arguments regarding hospital bed availability or a doctor's busy schedule—I just can't buy it. Those aren't valid reasons to rush a labor and risk someone's safety.

I’ve been thinking quite a bit about this lately—mostly because I find myself weighing whether I truly want to have a child with my partner. It started as a simple curiosity, but I’ve really begun digging into how the whole process actually works, moving from casual conversations with my parents to some much deeper discussions with my significant other. To be blunt, my biggest concern is her well-being. I can't stand the thought of her going through unnecessary pain or dealing with long-term physical consequences. Honestly? The idea of childbirth itself is pretty terrifying to me, especially when you factor in complications. I think about things like an episiotomy and how those injuries don't always heal smoothly—unlike the experience Grace Jackson11 had. That kind of thing keeps me up at night.

I’m glad I did my homework on this. Now I know that if we ever decide to go that route, my wife is going straight to the Chief of Medicine to insist on skipping the episiotomy altogether. Private care isn't cheap, obviously, but if it saves us from unnecessary complications or lasting trauma, it’ll be worth every single penny. Honestly, when I’m under the weather, a little bit of empathy and a kind smile can do just as much good as any prescription.

Grace Jackson11 said:I’m not entirely convinced that we always have to let a woman have the final say on everything she wants. It's a complicated thought, I know. Sometimes, you just have to wonder if total autonomy is always the most practical path forward.

😲 I have to disagree here. A woman is the sole master of her own body, and at the end of the day, her decisions are the only ones that should carry weight. You might argue, "But what if everyone starts demanding elective surgeries?" My response is simple: then they should be fully informed about the pros and cons of every available option. If she truly wants it, can afford it, and knows exactly what she’s getting into, then she should be able to access high-quality care without anyone else playing judge.

Like Grace Jackson11 said, I really hope we haven't scared anyone off. Sometimes the facts are just plain unsettling, but honestly, it’s better to face the truth now than to be blindsided later. I have to admit, whenever I picture some guy in a white coat performing unnecessary procedures on my wife—just hacking away at sensitive areas without cause—it makes my blood boil. It’s an instinctive thing. My adrenaline spikes, and suddenly that protective urge turns into this raw, aggressive need to step in and defend her. I hope nobody takes offense at me being so blunt about it.

Grace Jackson11 said:That’s going to cost a million stitches and a whole lot of scarring.

That’s the defining moment, isn't it? Once someone decides that a path is worth taking, I genuinely wish them nothing but the best. But my hope is that they look beyond just the emotional impulse. It’s easy to follow your heart, but you really ought to weigh the practicalities—everything from the gritty, messy details to the actual finances and long-term responsibilities. If you can balance the passion with some cold, hard logic, you're much more likely to find lasting happiness and stability. As for me, I’m still standing by my own decision. Still working on it every single day.

If anyone else happens to have some intel or a similar experience to share, please feel free to chime in. I’m all ears.

Justin Fox, you’ve definitely got some radical takes. Honestly, though, I think mine might be even more extreme. I really want to give birth at home. That’s my (informed) preference, but unfortunately, it's such a tough choice to actually make happen.

Anyway, I'm currently working with OBGYN patients at a hospital here in Chicago.

Justin Fox, man, you really need to take a closer look at the Patient Bill of Rights... specifically this part here:

II. PATIENT RIGHTS

The Right to Informed Consent

Article 6.

A patient's right to informed consent includes the right to be fully informed and the right to accept or refuse any specific diagnostic or therapeutic procedure.

Exceptions to the Right to Informed Consent

Article 7.

A patient's right to informed consent may be exceptionally limited only when justified by their health status in cases and in ways specifically defined by this Law.

Article 16.

A patient has the right to accept or refuse a specific diagnostic or therapeutic procedure, except in the case of an urgent medical intervention where failure to act would jeopardize the patient's life and health or cause permanent damage to their wellbeing.

So, yeah, major props to the patient and their autonomy, but at the end of the day, it's still the doctor who uses their expertise to judge what actually needs to happen. There isn't a single law out there that disputes that.

Besides, even the Hippocratic Oath says (Geneva modification 1948):

« Upon entering the medical profession, I solemnly pledge to devote my life to the service of humanity. I will hold my teachers in high esteem and respect them. I will practice my profession conscientiously and with dignity. I will make the health of my patient my first consideration. I will respect the secrets confided to me. I will maintain in all my dealings the honor and glory of the medical profession. I will consider my colleagues as brothers. In fulfilling my duty to my patients, I will not allow considerations of religion, nationality, race, politics, or social standing to intervene between my duty and my patient. I will respect, above all, human life. I will not permit considerations of race, color, creed, or caste, nor will I allow threats to influence my decisions, to lead me to use my medical knowledge contrary to the laws of humanity. This I solemnly pledge, freely and upon my honor. »

Is that enough for you? 😈
And hey, let's drop the "butcher" talk—you're insulting a lot of decent people with labels like that. As for the bad ones, well, they exist everywhere, but they aren't really our concern...

Susan Martin24, look, you’re a pro, but this law is just plain ambiguous. It boils down to this: the doctor makes the call, they’re supposed to give the patient the facts, but if they don't? There are zero consequences. I can't get behind a law like that. It needs an overhaul.

I personally refuse to accept a system where some doctor decides to amputate my leg just because I have a toothache, and then gets off scot-free simply because his colleague covers for him.

Just imagine how a woman feels when she says, "I don't want an epidural," only for the doctor to snap back, "It's not your decision to make." She ends up feeling like nothing more than a slab of meat on an operating table. Is that really how things should be?

Here’s another helpful link to a citizens' advocacy group fighting to fix these issues:

The Hippocratic Oath? Please, don't make me laugh. It’s a joke. According to that oath, doctors are meant to help, but most of the time, they couldn't care less about the patients.

Justin Fox, honestly, that last sentence you dropped was a straight-up insult to me.
Where do you get off acting like you can just trash people without any consequences? Because that’s pretty much your whole vibe lately.
Seriously though, would you mind telling us what you actually do for a living?
Because I have a feeling if I—or anyone else here—decided to say something "nice" about your actual profession, we might all be in for a surprise... 😈

A patient could walk into my office and say, "Hey, I want you to cut off my healthy ear."
I’m not doing that, no matter how much they beg. So, what, am I violating their rights now?
Give me a break!!!
My clinical judgment regarding their condition and what treatment they actually need is paramount—it takes precedence over what they want because it's rooted in actual medical science. Seriously, go talk to a lawyer about this.
Here’s an example: imagine a Jehovah's Witness needs emergency open-heart surgery where a blood transfusion is absolutely vital to save them. The patient refuses the procedure if it involves a transfusion, but the surgeon refuses to perform the surgery without one (any expert in the field will tell you I'm simplifying things here).
Go ahead, let's see how you'd solve that dilemma.
By your logic, Justin Fox, the surgeon should probably be electrocuted or at least stoned, right? 😈

I'm done arguing with you. Honestly, it feels like you might have some serious psychological issues going on; it seems like the idea of becoming a father has terrified you so much that you've lost your mind with all this "butcher" nonsense... If your girlfriend wants a kid (which is totally normal), hopefully she'll know to pick out a stable, sane father for him.
God help you... though maybe a psychiatrist could try too. 🙂

I simply must state that I am in complete agreement with Justin Fox—routine episiotomies are an absolute NO! And unfortunately, far too many doctors still practice them as if they were standard procedure. 😢
I have spent considerable time reading through every single article on Motherly regarding this topic (plus several other sites), and after scouring the birth stories shared by mothers on their forums, I find myself utterly horrified by the way certain doctors conduct themselves 😲 (and it isn't just limited to episiotomies, but a whole litany of other issues—honestly, it makes me want to fly abroad to give birth whenever I eventually become pregnant)
I lack the energy to write any more, so I will leave you with just this link to one particular article http://www.motherly.com/articles/text...t2ID=&Show=759

Rebecca Myers38, what’s your take on elective C-sections? I mean, when a woman specifically asks for one, not because there's some medical emergency or complication, but just because that's what she wants.
Do you actually think that choice is justifiable?
Or am I being too harsh by calling it "unnecessary surgery"?😬

Susan Martin24 said:Rebecca Myers38, what is your take on elective C-sections—you know, when a woman requests one purely out of preference rather than any actual medical necessity?
Can you truly justify such a choice?
Could this not also be classified as nothing more than unnecessary slaughter? 😬

In my estimation, this could easily fall under the category of "unnecessary butchery," though I haven't spent much time deliberating whether a total ban would be the solution. Instead, I would focus on ensuring she is fully briefed on every possible consequence—specifically the negative ones—and attempt to guide her toward a more rational decision. After all, how can one justify undergoing a procedure like a C-section when there isn't even a legitimate medical indication for it?
I find myself wondering if there is any actual purpose to my words, because quite frankly, I am completely lost. 🙂 I simply cannot bear to witness this any longer. 🙂

I mean, seriously, what’s stopping a pregnant woman from just saying she doesn't want an episiotomy? Is that even an option, or is it just standard operating procedure at our hospitals to perform them by default?

Susan Martin24 said:Justin Fox, that last sentence was a direct insult to me.
Where do you get off talking down to people like this? It's all you ever do.
Seriously, just tell us—what exactly is your profession?
Maybe I, or someone else here, might have a few "kind" words regarding your expertise... 😈

Susan Martin24, I’ve been following your posts on this forum for a while now. Based on what you write, I don't think you fall into that category of doctors Justin Fox keeps bashing. In fact, I'd say you seem like a great physician and a true humanitarian. 🙂

But look, try to see things from our perspective—the patients. Unfortunately, we tend to deal with negative experiences with doctors much more often than the good ones. 😢

coastaldriver4, just because a patient wants something doesn't mean it’s actually what’s best for them...

Take gallbladder surgery, for instance.
Nowadays, the standard is laparoscopic cholecystectomy. Instead of making one big incision right under the rib cage, surgeons just make four tiny little cuts—about an inch each—around the belly button and the sides of the abdomen. It's much less invasive.
But here's the thing: no matter how much a patient insists on avoiding a large incision, sometimes during a laparoscopic procedure, the surgeon has to switch gears and perform an open surgery. It happens when things get messy—maybe the anatomy is too tricky to see clearly through the camera, they can't get the bleeding under control properly, or there's way too much inflammation and scar tissue in the way. In those moments, you have to pivot to do what's necessary.

Look, I'm totally against cutting someone open or putting them on meds if it isn't absolutely necessary, but I truly believe the final call has to rest with the doctor. The idea that a physician would just do whatever they want out of some weird sadistic streak and then dodge accountability? Honestly, that sounds like something out of a fairy tale.
If we followed that kind of logic, it would be like saying bus drivers should just plow through cars or pedestrians whenever they feel like it...😈

Susan Martin24 said:coastaldriver4, a patient's wishes aren't always what's actually best for them...

Look, I get that. Honestly, if my doctor tells me that the absolute best move for both me and my kid is to go ahead with a procedure, I’m going to tell them to do whatever they need to do. I’m not sitting here questioning their expertise! But what I really want to know is: if it isn't strictly life-or-death, can I actually tell them *not* to do it? Or does the hospital have some rigid protocol where they basically "must" perform the surgery regardless?

🙂

There is a subtle but fundamental distinction here compared to other medical conditions—pregnancy isn't a disease, childbirth isn't an illness, and women giving birth aren't patients (nor should they ever be treated as such). Because of this, a woman should first and foremost have the autonomy to decide where, how, and with whom she chooses to give birth. Furthermore, in this specific context, she ought to have the right to access every possible resource to ensure a birth without tearing or unnecessary intervention; an episiotomy should only be performed if it is absolutely unavoidable and truly the superior clinical choice in that exact moment. In our hospitals, however, these procedures are performed routinely, much like so many other aspects of labor and delivery that have been reduced to mere checkboxes on a standard protocol.

Betty Bennett10 said:There’s this fundamental difference between pregnancy and actual illnesses—pregnancy isn't a disease, childbirth isn't a sickness, and women giving birth aren't "patients" (and honestly, they shouldn't be treated like patients). Because of that, a woman should first and foremost have the right to decide where, how, and with whom she gives birth. Secondly, in this specific context, she should definitely have the right to access every possible way to deliver without needing an episiotomy or tearing. An incision should only happen if it's absolutely unavoidable and truly the better medical choice for that specific moment. But here in our hospitals, they just perform them routinely, much like so many other standard procedures during labor.

Look, I totally agree with everything said there, except for that last sentence (though, to be fair, a lot of women unfortunately act like patients from day one—for instance, taking maternity leave way earlier than necessary. I have a friend who's a surgical resident in Baltimore who worked right up until seven days before her due date, then was back at the hospital three weeks after having the baby).
Regarding routine episiotomies, it's true they used to be done almost every single time, but lately, that's really changing. Wherever it's possible to preserve the perineum, doctors are doing that now, especially among the younger specialists. That said, you still run into some older doctors who just don't accept any other way. There's also been a huge shift toward different birthing methods, like water births—you see fewer incisions there, though if one is medically necessary, they'll still do it even in a tub...
As for the idea that birth is just "routine"—well, a normal birth *should* be treated as a natural part of life!
The bottom line is that a doctor needs to use their expertise to stand behind their work, and the final call on whether an episiotomy is actually required should rest with them, not the woman.
Otherwise, what's the point of having doctors at all if everyone thinks they know better than the professionals?

A decade or two ago, the medical consensus was that performing an episiotomy helped prevent long-term issues like uterine prolapse or bladder problems.

The data we have now shows that just isn't true. Still, you’ve got plenty of old-school practitioners who would rather reach for the scalpel than risk a woman tearing naturally.

To be fair, an episiotomy is still justifiable if the baby simply can't clear the birth canal.

In Europe, they used to favor lateral cuts—aiming toward the thigh—whereas here in America, the standard has been a midline incision toward the anus.

That midline approach has its perks: it tends to heal faster and causes less structural damage. The downside? If the cut slips and extends too far, you're looking at potential anal incontinence.

The lateral cut avoids messing with the anus, but it often fails to heal cleanly, leaving behind scarring and significantly dragging out the recovery time.

Susan Martin24 said:(though honestly, so many women act like they're terminal from day one of pregnancy—like, taking disability leave when they don't even need it... I have this friend specializing in surgery over in Baltimore who was working right up until seven days before she gave birth, and then she was straight back to the job just three weeks later)

Susan Martin24, I'm starting to think you've actually never been pregnant... 😉 😁

So, it’s not enough that I have to constantly worry about whether they’re actually going to perform the incision or not; now I also have to sit here and wonder if they’re going to cut left, right, or dead center? 😲

Honestly, I feel like just calling it quits and not working at all. 😁

Susan Martin24 said:My colleagues will be my brothers.

A bit of a tangent here... but I find this absolutely fascinating!