If you birth naturally and take measures to avoid tearing, you are likely to come out of it with an intact perineum, and if you do tear it will likely be superficial, through the skin only. Episiotomy always cuts through muscle and <i>guarantees</i> trauma to your genital area.<br><br>
Jagged tears heal together easier and faster, the sides can be more properly matched up when stitching (like fitting together the pieces of a puzzle,) and the resulting scar tissue is stronger, than if you start with a straight, clean cut. This has been long known in medicine, but surgeons like using scalpels which they can control precisely and which take less effort for them to suture together, and some still believe that episiotomy protects the pelvic floor because (as the theory goes) it does not have to stretch as much to birth the baby when an episiotomy is given. But then again many surgeons are simply trained technicians and not scientists nor critical thinkers. In fact, the human body is <i>made</i> to stretch, and those tissue fibers are extremely resilient when the right hormones are not prevented from making their way there.<br><br>
If you tear, it will be along natural stress lines and the body will self-minimize the damage. If you are cut, there is no telling how far the cut will extend, and for many women it extends into the rectum and cause further medical issues like incontinence and pain with defecation. Some women end up needing further surgery to deal with the extent of the damage.<br><br>
The cloth analogy is apt because the tissue surrounding the vagina is formed by an interweaving of fibers exactly like with cloth. As someone mentioned, you can do a simple experiment that shows how ill-thought out the pro-episiotomy argument is: take a piece of fabric and attempt to tear it in two. Nearly impossible isn't it? Now make a small snip with a sharp scissors and see how incredibly easy it is to separate the fabric into two pieces. If the fabric happens to have already begun to unravel or has been torn by getting snagged on something, it's still going to be difficult to tear further, because the tear will be jagged.<br><br>
So how do you minimize tearing? Well, stay away from things that will affect your tissue integrity adversely:<br><br>
-cold, dry air<br>
-feeling of being observed or self-conscious (causes tension in tissues)<br>
-hands on your tissues that are not your own (causes tension in tissues)<br>
-directed and forced pushing<br>
-pushing too soon (i.e. as soon as dilation as complete and before body begins spontaneously "throwing down")<br>
-pushing with unequal pressure applied by baby's head around outlet (which is one reason vertical positions are better)<br>
-an environment that interferes with normal hormonal release that affects flexibility and lubrication of tissues (i.e. lights, conversation, orders, eye contact, inhibition, etc.)
