The episiotomy

An episiotomy is a deliberate, small incision of a few centimetres performed to enlarge the vaginal opening to allow the baby to be delivered more easily.

The episiotomy is done at the time of delivery during a contraction while the patient is pushing.

Local anaesthetic is used when ever possible .

Episiotomy is performed when:
  • the baby is very large.
  • the baby is in an awkward position.
  • when the baby needs to be born quickly.
  • During a forceps delivery.

Pain and healing

  • Take regular paracetamol
  • Use an ice pack, or bag of peas on your stitches - this helps to reduce swelling and help with the pain
  • A warm bath, and gently pat yourself dry.
  • Ensure you wipe front to back after having your bowels opened, keeping the perineum area clean.
  • Allow the air to get to your stitches. Lie on your bed without any underwear on placing an old towel underneath you.
  • Avoid using a sanitary towel but if needed change frequently.

Keep active - pelvic floor exercises stimulate blood circulation which aids healing and the use of an inflatable rubber ring to sit on can be helpul to reieve the pressure on the wound when sitting down.

Episiotomy : v : Non episiotomy

It is crucial that mothers to be are fully counselled and informed of the risks, and benefits to having an episiotomy and that they are carried out appropriately and essential for the safe delivery of the baby. .
  • Studies have found no health benefits to having an episiotomy and that it's use routinely can be more harmful than if no episiotomy had not been performed.
  • In addition, routine episiotomies do not have a better outcome regarding stress urinary incontinence than having no episiotomy.

Therefore, many experts advocate that episiotomy should not be routine practice .

Facts and figures

  • 50 percent of expectant mothers who have given birth in the last few years have had an episiotomy.
  • Among them, 70 percent gave birth for the first time and approximately 30 percent had already had one or more children.

WHO recommends to lower this rate to 20%.
  • Campaigns carried out by associations in the UK have managed to decrease the rate of episiotomies from 52 percent to 13 percent.
  • In Sweden, the rate of episiotomy is of 6 percent.

The consensus among most gynaecologists is that:
  • Episiotomy does not prevent serious tears.
  • Episiotomy does not prevent urinary or anal incontinence.
  • A baby in an awkward position or in the case of twins does not justify a routine episiotomy.

Complications of an episiotomy

Lets not forget that an episiotomy is a surgical intervention and not a simple incision. Perineal tears can still occur despite having an episotomy and either can be very painful, and cause ongoing irritation. Complications include;
  • A tear of the perineum.
  • Damage to the anal and urinary sphincter muscles which may cause faecal or urinary incontinence.
  • The scar remains painful for 8 to 10 days until the stitches are removed.
  • Pain can persist for a month, even longer when walking or sitting. Some complain of pain for many years after an episiotomy.
  • Haemorrhage can occur several weeks after delivery.
  • Intercourse can be painful.

An expectant mother must receive sufficient information on the reasons for an episiotomy, the procedure, and its side-effects. Her decision, apart from an emergency situation, must be considered and taken into account by a member of the medical team.

A mother-to-be should be informed on the rate of episiotomies of the maternity unit where she will give birth. She can also ask not to have it carried out routinely.

Document produced in collaboration with Claire Gabillat
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