You may have heard the term “the kindest cut.” This is a twist on the quote from Shakespeare’s play Julius Caesar. During his speech at Julius Caesar’s funeral, Marc Antony refers to Brutus’ betrayal as “the most unkindest cut of all.”

This variation, “the kindest cut” has been used from everything from diamond commercials to breast cancer surgery. However, for me, during labor with my first child, it was aptly suited to the episiotomy.

An episiotomy is an incision, performed during labor to enlarge the opening of the vagina, and it was once a standard practice. The incision is made in the tissue of the perineum, the area between the vagina and the anus. This incision was originally intended to keep the tissue from tearing on its own, leaving jagged edges to suture rather than a straight incision line. It was also meant to help maintain bladder control after delivery, as it was thought it would help keep the bladder and rectum from dropping into the vagina post delivery. However, research has shown that an incision doesn’t heal any better or worse than a tear, and an episiotomy does not necessarily prevent incontinence.

However, there are some cases, like mine, where an episiotomy is necessary. After having been in a very normal, progressive labor, my baby was basically stuck at the base of my vagina, and no matter how many times I pushed, I couldn’t get him out. The opening of my vagina was just not stretching far enough to let his head pass. My OB, who generally performs this incision only when absolutely necessary, finally said that she honestly believed I wouldn’t be able to get my baby out without this cut. I consented, and she made the incision. My boy practically flew out of me on the next push. She was right; he just needed a little more room.

So, in some cases, an episiotomy is the kindest cut. Here are some cases in which this incision would be used:

- If it appears delivery will not proceed due to the size of the opening of the vagina

- If it is likely that severe tearing will occur, if the baby is in a difficult position for delivery

- If the baby is in distress and needs to be delivered quickly, and there is not enough time for the perineum to stretch out on its own

Be sure to talk to your OB about your birth plan before you go into labor so he or she will understand what your concerns/wants are. But remember, the best laid plans sometimes don’t fit the situation at hand, so be willing to be flexible, and trust your doctor to do what is right for you and your baby during delivery.

- Lee