Can Episiotomy be Avoided During Childbirth?

Episiotomy, can it be avoided? Is it impossible for mothers to give birth without it? It is a procedure that is sometimes necessary during vaginal childbirth, yet at times, it may not be needed at all. It can have physical, psychological, and social impacts on women. In this article, I will discuss its effects on women and provide some tips to help avoid it based on my experience as a childbirth educator who has accompanied many women during childbirth, as well as from a medical perspective gained through my work and studies as a nurse and public health expert.

Nisreen Nemer
Published on:Jan 7th 2024 |Updated on:Mar 10th 2024
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Reasons doctors do Episiotomy

Most doctors initially resort to this procedure when there is a medical need, such as:

  • Issues with the vagina during active labor: If this stage becomes prolonged and starts affecting the baby, leading to a slight decrease in the baby's heart rate, the healthcare provider may opt for an episiotomy to expedite the delivery.
  • The inability of the mother to push correctly: This could be due to pain relief options during labor or a lack of awareness about the appropriate moments for pushing.
  • Fetal position in the womb: The baby's position may hold back its exit without an incision.
  • Positioning for delivery: Certain delivery positions  (e.g., Supine position or lying on your back)are less favorable, and those that utilize gravity, such as sitting or standing, are generally better.
  • Lack of psychological and physical readiness: Insufficient education about pregnancy and childbirth or inadequate attendance at childbirth classes can contribute to the need for episiotomy.
  • Need for more readiness of the pelvic floor muscles: These muscles, crucial for pushing the baby, may not be ready.
  • Necessity to use forceps and vacuum for delivery: When forceps are required to assist in delivering the baby, an episiotomy may be necessary.

It's important to note that this medical procedure has become a routine aspect of childbirth in many countries,  even without a medical necessity.


  • Physical effects: Pain from the incision and stitches after childbirth.
  • Psychological effects: Pain during and after childbirth can affect a mother's desire for following pregnancies, potentially delaying a second pregnancy.
  • Emotional and social effects: Postpartum intimacy may be painful, leading many women to avoid intercourse, negatively impacting her marriage.

Can an Episiotomy be Avoided?

This is an incision done in the perineum, which is s a small area between the vagina and anus, and it can be avoided in several cases by:

  • Mental and educational preparation: Adequate mental and educational preparation for pregnancy and childbirth.
  • Physical readiness: Engaging in exercises, such as Kegel exercises and squats, a daily practice that used to be done by our grandmothers several times a day when using the bathroom, “Turkish toilets.” In addition to deep breathing, walking and climbing the stairs strengthen pelvic muscles and enhance flexibility in the perineal area. Doing all these practices throughout the pregnancy is essential to gain the best effect; doing them in the last few weeks won’t be as effective.
  • Choosing a mother-friendly hospital.
  • Selecting a doctor who prefers avoiding episiotomy who prefers surgical interference only when medically necessary.
  • Develop and review a clear birth plan with the healthcare provider.
  • Seeking support from a childbirth educator, a “Doula.”

Perineal Massage

Although perineal massage with oils during pregnancy is encouraged to reduce the likelihood of episiotomy, there is insufficient evidence of its effectiveness compared to the methods mentioned earlier in this article.

It's important to note that even with the above steps, spontaneous tearing of the perineum may occur during vaginal childbirth, which is a natural and normal occurrence. The severity of these tears varies based on perineal elasticity and the preparation of the pelvic floor.

Postpartum Care Steps

  • Use pain relievers as needed.
  • Apply cold compresses.
  • Use postpartum pads.
  • Care for the perineal area to ensure proper healing and prevent infections.
  • Follow up with a gynecologist until the incision is completely healed.

In conclusion, while episiotomy may sometimes be necessary, taking proactive steps in education, physical preparation, and healthcare choices can contribute to minimizing the need for this procedure during childbirth.

Nisreen NemerDoula

Nisreen graduated as a registered nurse from Sharjah University and received her master’s degree in Public Health from Hamdan Smart University. She is a lactation specialist, AMANI childbirth educator, Certified from AMANI Childbirth in Saudi Arabia, and a Doula. With years of experience in woman’s health care and health education, especially the education of pregnant women, to help them be prepared for childbirth. Nisreen dedicates all her time to supporting women in their motherhood journey and makes sure she does her role as a birth companion perfectly. She is always there for her clients from the first contraction, until the baby is born. She is passionate about helping women through birth and breastfeeding and other steps in their motherhood journey.

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