Childbirth

Episiotomy: what you need to know

An episiotomy is a cut in the perineum made to widen the vagina. It is practiced during delivery between contractions when the baby’s head appears.

What is it about

An episiotomy is a surgical cut that should be done under local anesthesia. How does it happen? In two possible different ways:

  • median (the cut is made starting from the lower part of the vagina towards the anus)
  • mediolateral (diagonally down and then away from the anus or first down and then out forming an L-shaped cut).

The incision affects both the dermis and the underlying muscles and therefore requires careful suturing (stitches) of the wound.

It is easier to suture a median episiotomy than a medio-lateral one or a “natural” laceration.

Why is it practiced?

Episiotomy is practiced to avoid lacerations during childbirth that are difficult to suture and therefore to facilitate the passage of the baby.

Obviously there are conflicting opinions on the matter.

Some gynecologists practice it routinely indicating that a clean cut is always better than a laceration of muscle tissue, or small and deep internal lacerations.

Others prefer not to argue that a laceration is acceptable if it occurs.

Specific cases

Clearly when there are signs of fetal distress , episiotomy speeds delivery and is useful for the unborn child. Other cases in which it is justified are:

  • abnormal presentations
  • previous 3rd or 4th degree lacerations
  • parto podalico
  • shoulder dystocia

In summary, let’s see when it is recommended to do it:

  • the lack of elasticity of the perineum is one of the main reasons why it is carried out and this eventuality can happen during the first birth because the tissues are less elastic
  • in a woman who has had a previous episiotomy it may be necessary again because the scar tissue from the first cut is less elastic. In this case the episiotomy is done in the same line as the previous episiotomy
  • specific cases of fetal distress, breech presentation, shoulder dystocia

How to avoid episiotomy

However, some studies conducted in Canada and Great Britain have shown that episiotomy does not present great advantages over a first or second degree laceration.

It also seems that the healing times for those who have undergone an episiotomy are longer than those who have had a simple laceration.

It can also cause other problems that must be considered when you decide to do it. If done too early, i.e. before the perineum thins, it could cause bleeding. Also, sometimes the cut is larger than a normal laceration.

With a more natural birth and adequate assistance, it has been found that fewer and fewer women report lacerations to the perineum and this makes the mother’s condition better in the days and weeks following childbirth.

It is possible to prepare the perineum for childbirth so that it is more elastic and there is less risk of laceration or having to resort to an episiotomy. Read more:

What to do after the episiotomy? When do points drop?

The suture is usually performed by the gynecologist after the delivery of the placenta.

The wound is checked every day during the hospitalization and 40 days after delivery during the routine checkup. Stitches are resorbable and fall off on their own during this time. It can be a little annoying in the first few days and especially when sexual activity resumes .

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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