An episiotomy is a cut made along your perineum by your doctor during labor. Your doctor may need to cut your vaginal opening to allow more room for your baby to be born safely and without harm. However, the cut can be made in two different ways. Learn about the differences between the two types of episiotomy.
Understanding Episiotomies
Your perineum is the area of skin between your vagina and anus. Your doctor uses a scalpel or scissors to make a small cut that enlarges the vaginal opening, making more room for your baby’s head. This method is only used once your baby is crowning if the doctor determines that it is necessary for your baby’s safe delivery because of their size compared to the size of your vaginal opening.
The most common episiotomy in the US is performed on the midline, which is directly above your anus. The second kind of episiotomy is called mediolateral and is cut slightly to one side or the other of your perineum. A mediolateral episiotomy is more common in other parts of the world.
One study showed that a midline episiotomy has an increased risk of damaging your anus and anal sphincter. On the other hand, a mediolateral incision has a higher risk of injury to your ipsilateral nerve and surrounding muscle, erectile, and gland tissues. Once you deliver your baby and the placenta, your doctor repairs the incision immediately.
The cut your doctor makes is given a grade based on the severity of the cut. This includes:
- First degree: This cut includes your vaginal mucosa and perineal skin but doesn’t cut any underlying tissue.
- Second degree: This cut also includes your underlying subcutaneous tissue and your perineal muscles.
- Third degree: This cut goes deep enough to impact the musculature of your anal sphincter.
- Fourth degree: This cut goes deep enough to extend through your rectal muscle and into your rectal mucosa.
Episiotomies aren’t necessary for every birth. In fact, many medical professionals don’t recommend using them at all. Your tissue stretches naturally to accommodate your baby, and if your skin tears, it is usually not as deep as a cut would be.
Benefits of a Midline or Mediolateral Episiotomy
Benefits of a midline episiotomy are similar to the benefits of a mediolateral episiotomy. Either cut offers the chance to shorten the time you spend delivering your baby. If you’ve been pushing for a while with no progress, a cut may offer just enough space for your baby to move further down and out.
Each tear offers the benefit of not affecting different muscles and tissue than its counterpart. If you already have existing rectal issues, your doctor may choose to perform a mediolateral episiotomy instead.
A faster delivery is often more convenient for a doctor who may have other patients to care for. However, it’s also beneficial to your baby. The longer your baby is in the birth canal, the higher their chance of complications following delivery.
Some doctors also do episiotomies if the baby's heart rate is low if they feel like it would help the baby deliver faster. ---can add this at end of first or last paragraph.
Risks of a Midline or Mediolateral Episiotomy
Both types of episiotomy also offer similar risks. The complications are also the same as they would be if your perineum tore spontaneously during delivery. If you’re against an episiotomy prior to delivery, talk to your doctor. While you may tear either way, your doctor may try to honor your wishes if it’s possible during your delivery.
Risks of an episiotomy include:
- Bleeding
- A longer healing time
- Complications for future vaginal deliveries
- Dyspareunia
- Pelvic floor issues
- Urinary fistulas
- Visible scars or internal scar tissue that is painful
A deep cut during your midline or mediolateral episiotomy may cause additional concerns like damage to your external anal sphincter muscle. This may lead to incontinence issues or the formation of a fistula. With this consideration, a mediolateral episiotomy offers slightly less risk.
Additionally, cutting your tissue actually encourages a deeper tear than if your skin tore on its own. This means that even if your doctor makes a small incision, the pressure of birth is more likely to deepen the wound than if you tore as a result of the pressure of birth.
Other Considerations
If you want to prevent the need for a midline or mediolateral episiotomy during your delivery, use these tips:
- Try a different position during labor that puts less pressure on your perineum. For example, you may lie down on your side or rock on your hands and knees.
- Understand when and how hard to push so you don’t cause damage to your tissue by pushing at the wrong times.
- Have someone use a hot, moist cloth to apply pressure to your perineum when your baby’s head crowns.
- Use perennial massage to prepare the skin for stretching during the delivery.
