What heals better - natural tear or episiotomy?

[PSL1990]

Which one heals better? Natural tear or episiotomy?

I've been told by a consultant that an episiotomy is preferable because they can control the depth and direction whereas a tear is more likely to damage nerve endings, various muscles and it can be more tricky to stitch back up. A consultant will have more experience of attending medicalised births with these sort of interventions though..

I'd say episiotomy as it's a controlled cut .. mine healed very quickly .

IME a tear heals better

It depends on the tear.

A small uncomplicated tear that isn’t in a difficult to heal area and doesn’t damage any nerves will heal much quicker than an episiotomy.

But an episiotomy will heal much quicker and better than let’s say a 4th degree tear that leaves you faecally incontinent and gets infected.

Episiotomies can also tear, known as an extended episiotomy and then you have both.

Impossible to say either way. Hence episiotomies are not done to prevent tearing and only done for instrumental deliveries or to expedite delivery.

In my opinion an episiotomy heals better.
I tore 5 weeks ago with my second baby and I’ve had much more pain with a tear and abrasions than I did with a cut.
I’m still very uncomfortable and sore where my stitches are.

I had an episiotomy and it healed really quickly.

I had episiotomies with both of my births and they healed very quickly with no issues whatsoever.

I asked that question 2 minutes before a ventouse delivery. The consultant shrugged and said there was no right or wrong. I elected not to have the episiotomy as I had heard natural tears heal better. Immediately post- delivery and a 3c tear, she said "You should have had the episiotomy." Well, thanks.

The doctor doing my stitches was excellent and it all healed well but my experience made me think that perhaps episiotomies are preferable as they are more controlled? Although I'm assuming an episiotomy can still tear.

I had an episiotomy 10 weeks ago and my stitches had dissolved externally within 2 weeks and the scar is so neat it practically looks the same down below as before. The epi at the time was sore as they didn't wait for the local anaesthetic to kick in and just snipped away but it obviously was necessary as she was born with the next couple of pushes. It sounded like when you cut chicken up with scissors 😂😂😂

I've heard various things from various medical sources.
Episiotomies are more controlled so therefore may be smaller than if you were to be left to tear naturally, however episiotomies can still tear beyond the cut. They are also neater so can be easier to repair and therefore less infection possibilities.
However I was also told that tears can be more beneficial as the rugged edges of the tear mean that if it is repaired well, the skin will heal better long term as its like puzzle pieces fitting neatly back together as opposed to trying to line up 2 straight edges perfectly.

I had a 3b tear and it was well repaired. I was still sore for around 5 weeks but I can't even see the scar tissue there 5 years later and all the midwives, tear clinic staff etc commented about how good it looked and how well it healed.

For me, I really think there are so many other factors just like with actual labour itself that you don't know which is best as both can have positive and negative outcomes. You could tear, but it have been better to be cut, or be cut and it have been better to tear. Without being able to fast forward and see both outcomes, it's a guessing game.

I think the science says that on average a tear is better - that's why episiotomies are no longer routine and the nice guidance is quite specific about the circumstances when they should be used.

Having said that I had an episiotony - pretty sure outside of the nice recommendations - and it caused me no problems and virtually no pain at any point.