An episiotomy is an incision (cut) made in the perineum (skin around your genitals) between the vaginal opening and the anus. This is done to make it easier for the baby to pass through the vagina.
The cut is made with surgical scissors under a local anaesthetic just as the baby’s head appears.
What are the reasons for an episiotomy?
An episiotomy will be necessary if:
- The perineum has not had time to stretch properly
- The baby’s head may be too large for the vaginal opening
- You cannot control your pushing so that you can push down gradually and smoothly
- The baby is suffering distress
- You need a forceps or vacuum (ventouse) delivery
- You have a breech birth
Can an episiotomy be avoided?
- Your position during labour and birth is important. You need to tell the midwife or doctor that you want to avoid lithotomy or the recumbent position. A semi-upright position will help avoid an episiotomy if your labour is progressing normally.
- Learn to relax the muscles of your pelvic floor and allow your vaginal tissues and perineum to bulge out, which helps to avoid a tear.
- It tends to be assumed that an episiotomy and an epidural go together. If you make it known that you do not want an episiotomy and want to control the end of the second stage of labour, an episiotomy is often not necessary.
After an episiotomy
- Many women find that they experience more pain from an episiotomy than from a tear and may find it difficult to get into a comfortable position to hold the baby.
- Some women experience pain during breastfeeding from the wound which distracts them.
- An episiotomy appears more likely than a tear to lead to discomfort or pain during intercourse as long as three months after delivery.
- Some women find the stitches uncomfortable.
- Discuss the possibility of an episiotomy with your midwife or doctor before you go into labour and make it clear that you would rather avoid this if this is the case.