Episiotomy – What Do You Need To Know?



What Is An Episiotomy?

An episiotomy is a surgical cut made into the perineum (area between the vagina and anus) to enlarge the opening before the birth of the baby’s head. It helps to ease the birth of the baby when the mother is having difficulty getting her baby out.

Although episiotomy is one of the most common surgical procedures carried out on women during childbirth, the medical value of episiotomy is still open to debate.

As women become more informed about labour and birth and are more involved in the decisions regarding their care, the necessity for routine episiotomy is being questioned.

Recent studies show that episiotomies are often performed unnecessarily and therefore the indications for doing them are being reviewed. Studies show that routine episiotomy is not required for most births. There is also controversy over whether an episiotomy is preferable to a tear. We will explore this topic during this article.

When Is An Episiotomy Necessary?

Many experts agree that the following are valid reasons for giving a woman an episiotomy however there are individual circumstances in every birth. Although the below are some instances that you may need an episiotomy, not every woman with the below issues will require one.

If The Baby:

  • Is in the breech position (bottom first instead of the usual head first position) and is born vaginally, at times there may be a need for an episiotomy
  • Is premature and cannot tolerate prolonged pushing against a perineum and there is slow progress of the birthing of the head
  • Is in distress and needs to be born quickly. An episiotomy can reduce the length of the second stage of labour and expedite the birth
  • Needs easing out by forceps or ventouse (vacuum cup)

When Is It Not Necessary?

A debatable reason for doing an episiotomy is when the doctor or midwife feels that the perineum (the skin and tissues between the vagina and anus) is likely to tear as the baby’s head is born.

Studies have shown that when a tear occurs, it may be less painful and heal faster than an episiotomy, and not the other way around. Women with tears have also been found to resume sex sooner and with less pain than women who’ve had an episiotomy. So with this in mind, you will find many health care settings do not perform ‘routine episiotomies’.

Most Obstetricians and Midwives in Australia only use an episiotomy when it is truly necessary.

Ways To Reduce The Need For An Episiotomy

During the birth of a baby, Midwives encourage the mother to ease the baby’s head out slowly (this is often when you will hear the Midwife use the words ‘pant, pant, pant’). You will also be encouraged to use a position, which is aided by gravity, and often you will find the Midwife will support your perineum to help minimise tearing or the need for episiotomy.

Massaging The Perineum

Massaging the perineum with natural oil (grape seed/sweet almond oil/olive oil/coconut oil) for six weeks before your due date can improve the pliability of the skin and underlying tissues. This massage also helps women become familiar with their anatomy and accustomed to stretching sensations, which are common during the birth. You can find out more about perineal massage below.

Try To Avoid Pushing Using Sustained Breath Holding

Try to avoid pushing using sustained breath holding, rather use gentler expulsive, spontaneous pushing, without excessive straining, to ease the baby down through the birth canal and out. By preventing excessive straining during pushing you can reduce the over stretching of the pelvic floor, as well as push your baby out more effectively. What I mean by ‘sustained breath holding’ is ‘holding your breath and pushing as hard as you can – taking another breath and repeating this’. With an epidural we often need to do this type of pushing however if you do not have an epidural on board we would encourage you to listen to your body and push your baby out spontaneously.

I would encourage you to include in your birth plan and discuss with your Midwife/Obstetrician your wishes about episiotomy. Every birth is different and every woman is different. There will be times where an episiotomy is definitely needed. Have trust that your Midwife and/or Obstetrician will do the best for you and your baby during your birth.

You can find out more about vaginal tearing here.

Written by Midwife Zoe

(This article contains general information only and is not intended to replace advice from a qualified health professional. All information is written from the experience and knowledge of the person writing the post).