The way to make this article shorter would be to state that the most important thing to know about episiotomies is that they are rarely needed, if ever. In most hospitals that are up to date on the current research, episiotomies are not being done routinely. They are only used in cases of true emergencies where the tissues are what is holding the baby back from being born.
Episiotomies are an excellent topic to discuss with your care provider before labor. Finding out how often they perform episiotomies and their reasoning for doing so is a great way to determine if they are going to be a safe care provider for you. Another recommendation would be putting your desires for episiotomies into your birth plan or preferences so your care provider can see them.
The Reasons for an Episiotomies
One of the most common reasons for performing an episiotomy would be shoulder dystocia, where the perineum and vaginal tissues are too tight to complete any internal maneuvers.
The safest practice for episiotomies is that they are only performed when harm could come to the baby if not performed.
The History of Episiotomies
The history of episiotomies is that they were given to lessen the tissue trauma caused by childbirth. It was once believed that episiotomies reduce the degree that a natural tear would have caused. After many years of routine episiotomies, we have found that the opposite is true. 
Tearing naturally is the best way to avoid greater degrees of tears and much of the difficulty that can come with healing from an episiotomy. I like to describe it in this way. When trying to tear fabric, it can be challenging if you just start pulling on a non-cut piece of cloth. Usually, you make a small cut in the material, and then it is easier to tear it apart from there. Much is true about the vaginal and perineal tissues. An initial cut can cause a much more in-depth tear of tissues.
How Are Episiotomies Given?
There are a few different ways that episiotomies are given. The two most common will be discussed below.
The first kind is a Midline incision. Midline incisions are more common in the United States. The midline cut is directly above the anus. The benefits are that these types of episiotomies are easier to suture, heal from, and less painful, but the risks here are for the cut to tear further and enter the anus.
The second kind is the Mediolateral incision, which is more common in other areas of the world. The mediolateral cut is slightly to one side of your perineum rather than straight up and down. The main advantage of this type of episiotomy is that it is less likely to tear into the anus, causing significant muscle damage and possible long-term complications. The disadvantages of the mediolateral incision are that it can increase blood loss, is more painful, creates a more complex repair, and has a higher risk of long-term discomfort.
The Natural Tear
The best possible scenario for tissue damage during birth is a natural tear. Although natural tears are more difficult repairs for providers, they heal much easier and quicker. Tearing is also something that can be lessened and even avoided if helped by the care provider.
Slowing pushing during crowning, perineum counter pressure, and oil and heat on the perineum can all help with the severity of tissue damage. Tearing naturally reduces the amount of blood loss, infection, incontinence, and perineum pain.
It is crucial that you do your research and advocate for yourself for your wants and desires during your birthing time. If advocacy feels like a lot while birthing a baby, having a partner or doula who can help with that advocacy is another excellent idea. Remembering that the most current research is that episiotomies should only be performed in cases of genuine emergency is a great way to remember that what you are educating yourself and your provider about is based on facts.
