Which Is Better: Episiotomy or Tearing?

Which Is Better: Episiotomy or Tearing?

The Real Deal

It’s a subject that most moms to be do not want to talk about. Which is better, an episiotomy or perineal tearing. (Can one of those things be better than the other? They both sound horrible!) The truth of the matter is, when you have a baby and deliver vaginally, sometimes the baby’s head just won’t fit through.  Claim Your 20 Free Pregnancy Tests – Click Here

Either you will need the doctor delivering your baby to perform an episiotomy, or you will have to tear naturally. Neither one is ideal, but you should at least be prepared and informed about both options so that you will know what to expect no matter what happens during your delivery. Read on for more info about both options, and then decide which one you think is best.


An episiotomy is a surgical cut made by a doctor in the area between the vagina and the anus to enlarge the vaginal opening. If you need an episiotomy, your doctor will do it right before you deliver your baby. The belief behind an episiotomy is that a “clean, surgical cut” will heal faster and easier than tearing naturally.

However, episiotomy is now losing it’s popularity, and the American Congress of Obstetricians and Gynecologists says that it doesn’t offer any real benefits over natural tearing. In fact, it might even cause problems, and experts agree that it shouldn’t be done routinely.

In 1979, 2 out of 3 births were done using an episiotomy, but in 2004, only 1 in 5 births were done with an episiotomy. Some moms think that episiotomies are less painful during delivery, but offer a much more painful recovery process.

Natural Tearing

Natural tearing is just exactly what it sounds like. A spontaneous perineal tear is the tearing of the vaginal tissue or pelvic floor muscles caused by the pressure of the baby’s head on the vagina. There are four levels to spontaneous tearing.

A first degree tear is superficial, and involves only the skin around the vagina. A second degree tear is a little worse, and goes a little bit deeper into the muscle. This kind requires stitches to repair. A third degree tear is even worse, and involves the tearing of the skin tissue and the muscle tissue both.

A fourth degree tear is the worst. It is even painful to write about, as it involves the tearing of the skin around the vagina, the muscles, and the anal sphincter as well. Tearing can be very painful during delivery, even with an epidural, but most doctors agree that natural tears cause the mother to lose less blood and heal more quickly and completely than episiotomies.

What To Remember

Now that you know the difference between episiotomy and natural tearing, you can talk with your doctor about your feelings on the two. Your doctor might be able to manipulate your baby using forceps or other means, to help avoid an unnecessary cut. You might want to look into perineal massage for a few weeks before your delivery, which can also help you to avoid needing an episiotomy, and can even help you to avoid tearing.

These days, episiotomies are only done when there is an emergency situation and the baby needs to come out to avoid serious injury or even death. Just know that if you have a choice, you might want to avoid it, but if it has to happen, you will be just fine afterwards.

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Dr. Christine Lee, MD
Dr. Christine Lee, MD | ConceiveEasy
Dr. Christine Lee earned her Ph.D. in Developmental Biology and Master of Science in Biomolecular Organization. Dr. Lee is Lab Director for ConceiveEasy and is board certified as a High Complexity Laboratory Director (HCLD).