Choosing to avoid an episiotomy can lead to less pain, better pelvic recovery, and improved sexual function

Episiotomy: not always needed, and often with real benefits when it isn’t done

If you’re studying for doula work, you’ve probably heard the term episiotomy—and you’ve likely heard the questions that swirl around it. A surgical cut in the perineum during birth can seem like a quick fix in the moment, but there’s growing emphasis on letting birth unfold more naturally whenever possible. Here’s the thing: not performing an episiotomy can carry several advantages that show up in the days, months, and even years after birth. The big idea is simple—preserve natural tissue, respect the body’s healing pace, and support long-term well-being. Let me walk you through the main benefits and what they mean in real life.

Less pain after the baby is born

Pain is a very immediate, very human experience after a baby arrives. When an episiotomy is avoided, the perineal tissue often heals with less trauma. A surgical cut is precise and deliberate, but it introduces a scar and a different healing trajectory than a natural tear. For many birthing people, natural tears that occur without a surgical cut heal with less overall discomfort in the first days and weeks.

Why does this matter? Pain can influence rest, mobility, and even appetite in those precious early postpartum hours. If you’re supporting a client who’s recovering, you’ll notice that easier, less painful healing often translates to better sleep, quicker return to gentle movement, and a more positive mood as the body begins to reset after labor. Of course, every birth story is different. Some tears can be quite shallow, some deeper—whether a cut was avoided or not. The point is that, when possible, avoiding a surgical incision can reduce the intensity of postoperative pain.

Pelvic muscles stay more relaxed and intact

Think of the pelvic floor as a hammock of muscles supporting bladder, uterus, and bowel. An episiotomy involves cutting through perineal tissues, which can affect how these muscles recover and function. In many cases, avoiding the incision helps preserve the natural elasticity and integrity of the pelvic floor.

Why is that important? The pelvic area is a busy neighborhood of nerves, muscles, and connective tissue. If a surgical cut alters this landscape, it may take longer for the muscles to regain their usual tone and coordination. For some people, this can mean a slower recovery of pelvic floor function and, occasionally, challenges like urge incontinence or vaginal heaviness down the line. When the tissue heals without a cut, the natural architecture stays closer to its original state, which can support smoother rehab and lower the risk of long-term pelvic floor concerns.

Better sexual function later (fewer long-term commotion)

This topic isn’t the flashiest part of birth talk, but it matters a lot to many people. Tissue preservation, nerve continuity, and scar formation all influence sexual health later on. An episiotomy introduces scar tissue and can disrupt the normal sensory wiring in the perineal area. If a person can avoid that surgical cut, they’re more likely to maintain sensation and comfortable mechanics as intimacy resumes or evolves in the weeks and months after birth.

In practical terms, many individuals report that avoiding an episiotomy correlates with fewer problems related to sexual function down the road. That doesn’t guarantee a perfect experience every time—there are many factors at play—but the research and clinical experience tend to favor approaches that respect natural tissue and nerve pathways whenever feasible.

Putting the pieces together

So, the three big threads come together like this: less immediate pain, a pelvic floor that can relax and recover more naturally, and a lower risk of long-term sexual health complications. All of these translate into a smoother postpartum arc for many birthing people. It’s not a guarantee that no one will ever need an episiotomy, but it’s a solid argument for preferring natural tearing over surgical cutting when the obstetric team determines it’s safe and appropriate.

There’s also a helpful nuance to keep in mind. When perineal tissues stretch more gradually and tear along natural lines, healing can sometimes proceed with fewer complications. A cut, while controlled, creates a clean surgical edge that heals differently. The choice isn’t just about one moment in the birth—it’s about the body’s ongoing recovery trajectory and future quality of life.

What doulas and families can do to support this approach

Knowledge without action isn’t very useful, so here are practical steps you can discuss with families and bring into a birth plan (when it aligns with medical guidance):

• Talk through preferences early. A clear, informed conversation with the care team helps everyone understand the family’s values and the plan for perineal care. It’s not about preventing all interventions at all costs; it’s about knowing options and their potential effects.

• Prepare the perineum as birth approaches. Perineal massage, warmth, and controlled pushing can reduce the likelihood of an episiotomy when the team supports a natural tear instead. This planning isn’t a guarantee, but it’s a constructive way to reduce perineal trauma.

• Support positioning and pacing. Positions that minimize perineal stress during the crowning phase can help. For some people, different birthing positions or guided breathing can reduce the need for surgical cuts and support a more gradual stretch of tissues.

• Equip caregivers with evidence-based alternatives. Techniques like controlled pushing with a relaxed jaw and shoulders, and the use of warm compresses during the second stage, can soften the perineal tissues and create a more favorable stretch.

• Emphasize informed consent. Encourage families to ask, “What are the indications for an episiotomy in this case? What are the risks if I decline?” The clearer the dialogue, the better the shared decision-making.

• Normalize varied experiences. Nobody’s birth story is exactly the same. Even with a plan, things shift in a heartbeat. The goal is to support the person’s body through childbirth with compassionate, evidence-informed care, rather than sticking to a rigid script.

A gentle note about the boundaries of choice

It's worth acknowledging that not every birth follows the same script. There are medical scenarios where an episiotomy is medically warranted to protect the baby or the birthing person. In those moments, the decision is made with careful professional judgment, not as a preference. Your role as a doula or caregiver is to present options, support the person’s values, and help navigate the moment with calm, clear communication.

A few quick takeaways

• The overall benefits of not performing an episiotomy include less pain after birth, better pelvic floor recovery, and potentially healthier long-term sexual function.

• The choice depends on the clinical context. When safe and appropriate, avoiding the cut can lead to a smoother recovery.

• Preparation and informed conversation are essential. Perineal care, gentle stretching, and mindful pushing can influence outcomes.

• Always align with current guidelines and the care team’s judgment. Comfort with the plan grows when everyone understands the reasoning behind it.

Real-world relevance, not abstract theory

If you’ve ever supported someone through birth, you know how tangible these issues feel. The body’s healing is intimate work—tender, sometimes surprising, and deeply personal. The idea that not cutting the perineum can reduce pain, support pelvic-floor function, and preserve sexual health isn’t just a line on a page. It’s a lived reality for many people who remember those early postpartum days with a little more ease and confidence.

Closing thoughts

Birth is a journey that blends science with human experience. For many people, choosing to avoid an episiotomy when possible yields meaningful benefits that persist beyond the first week or two after birth. It’s about respecting the body’s natural design, supporting recovery, and keeping options open for the future.

If you’re helping families navigate birth, you’re not just sharing facts—you’re offering a framework for comfort, confidence, and care. And that, in the end, can make all the difference as a baby meets the world and a family starts to settle into life with a little more ease.