If your mom, grandmother, or older sister had a vaginal delivery, there's a good chance that they also had an episiotomy. For years episiotomies, an incision in the tissue between the vagina and the anus, were routine procedures performed by doctors in order to assist in the birthing process and prevent jagged tearing which is harder to suture. But are these incisions necessary and can you refuse an episiotomy?
The short answer is, yes. That is, as long as you make sure to discuss your wishes with your doctor, add it to your birth plan, and your baby is not in distress during delivery.
According to the Mayo Clinic, episiotomies were thought to heal more quickly than a natural tear and were intended to preserve the muscular and connective tissue support of the pelvic floor. Recent research, however, suggests that routine episiotomies don't prevent these issues, and can actually cause more damage. Risks of episiotomies include bleeding, tearing into the rectal tissues as well as the anal sphincter muscle which controls the passing of stool, swelling, infection, collection of blood in the perineal tissues, pain during sex, and other risks depending on your specific situation, according to Johns Hopkins Medicine.
Parenting recommended that when choosing an OB-GYN, you should always ask the doctors what their rate of episiotomies is and under which circumstances they perform them. There are parents, like Cyndi Sellers interviewed by The New York Times Motherlode, who have claimed that their doctors allegedly performed unnecessary and rushed episiotomies to speed up the birthing process so they could return to whatever they were doing prior to being called in for a delivery. If you want to avoid an unnecessary episiotomy, researching your potential doctor's reputation in regards to the incision is a good first step.
Even if you and your doctor have discussed your episiotomy concerns and refusal, there are circumstances in which your doctor may strongly suggest the incision. According to Sanford Focus, your doctor may recommend performing an episiotomy if your baby is very large, shows signs of distress, needs to be delivered quickly, is in an abnormal position, or if extreme vaginal tearing is likely to occur. If a doctor must use forceps for the delivery, an episiotomy will likely be needed, as well.
Your request to avoid an episiotomy should be added to your birth plan. In the event that your regular doctor is unable to assist in your delivery, you want to make your wishes clear. Don't be afraid to be upfront with the medical staff and you can always ask your partner or labor coach to verbalize your wishes, as well.