Do You Have The Right To Refuse An Episiotomy?

by Shannon Evans

I had the birth I'd planned for my first baby: vaginal, no epidural, and in a birthing center rather than a hospital. What came as a surprise, however, was that the only reason my plan worked out was because of an episiotomy. As modern women, most are wary of this practice and want to know the facts. So when is it necessary, and do you have the right to refuse an episiotomy?

An episiotomy is a surgical incision made in the vaginal opening during childbirth that had its peak in the 1970s as a routine hospital practice performed on more than 60 percent of women in delivery nationwide, according to a National Public Radio (NPR) report. But over the years, researchers, mothers, and some medical professionals began expressing concern with it being used as a routine measure, citing unnecessary injury and more painful recovery for women.

In an interview with NPR, Dr. Alexander Friedman, lead author of a report on episiotomy rates in the Journal of the American Medical Association, said that notably high rates at certain hospitals or by individual doctors are a red flag, as they indicate all instances are not medically necessary. Friedman told NPR that an appropriate episiotomy rate should be around 10 percent.

So if they aren't always medically necessary, why might an episiotomy be performed? It was once assumed that a clean cut was better for a woman than a vaginal tear, but that is now widely rejected since there's no way to know whether a woman will tear at all or how significant the tear would be. Some physicians rely on routine episiotomy to speed up the delivery process, which shows a lack of respect for the process of a woman's individual body. And unfortunately, some continue to perform them because it's simply what they've always done.

There are cases in which episiotomy can benefit delivery, if done with the mother's consent: When an infant's heart rate drops, his shoulder is stuck, or the mother is exhausted and requests one. In those cases, an episiotomy can be very strategic and important to the health of mother and child, according to Eva Martin, MD and founder of Elm Tree Medical.

As with any medical procedure, you absolutely have the right to refuse an episiotomy. Martin, in a piece written for Elm Tree Medical's website, emphasizes, "Consent is not a luxury; it is a necessity. No woman should be subject to medical procedures against her will." You can always refuse an episiotomy, but you should also talk with your doctor or midwife before the birth to express your feelings on the issue. If you feel your provider isn't on the same page, it might be time to find someone new.

When my sunny-side-up baby hadn't emerged after over three hours of pushing, my midwife leveled with me: I could opt for an episiotomy, or we would have to transfer to the hospital. (My baby was not in danger, I was simply out of steam.) I didn't have to think twice before asking for an episiotomy, and my sweet son was out just a few minutes later. I know without a doubt that an episiotomy was the right choice for me in that moment, but I'm glad my midwife made it clear that it was just that: my choice.