An episiotomy is a surgical cut made by the doctor during vaginal birth to enlarge your vaginal opening to help deliver the baby. The cut is made between your vagina and your anus. In India, as in many developing countries, episiotomies can be practiced as a routine by the doctor. Research shows that episiotomies should be restricted to cases where they are required1,2 and the World Health Organization is quoted as saying that episiotomies should not be a routine3.
As an expecting mother you should have a conversation on episiotomies with your doctor, in the third trimester. You and your doctor should agree that sound medical reasons must exist before an episiotomy is undertaken. You will be in no position to have this conversation during delivery and therefore it is better to agree on this beforehand.
After delivery, the doctor administers stitches to close the surgical cut. If you have already had an epidural, you will probably not need any further medicines. Otherwise, a pudendal block (used in the late stage of labor) is used to numb your perineum during an episiotomy.
An episiotomy may be needed in the following cases:
- You are in labour but your perineum (the diamond-shaped area between your legs which includes the anus and the vagina) hasn't stretched enough
- Your baby's head is too large for your vaginal opening
- Your baby may have to be extracted using an instrument like a forceps
- Your baby is in distress or other complications exist
An episiotomy does heal on its own over time. However, it does slow down your physical recovery after giving birth. And you may have to take a longer break from sex as it can be painful during the healing process.
You will also have to protect yourself from infection during the healing, by being extra clean. When cleaning the area, splash water on it rather than applying your hands on it or wiping it.
1. "Routine episiotomy in developing countries", A Maduma-Butshe, Adele Dyall, Paul Garner, BMJ 1998;316:1179-1180
2. Carroli G, Belizan J. "Episiotomy for vaginal birth", Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000081
3. Thompson A. Episiotomies should not be routine Safe Motherhood Newsletter, Geneva: World Health Organisation, 1997:12 (From Reference No 1)