What is an episiotomy and when is it needed?


by Mother & Baby |

Episiotomy. You might be wondering what on Earth it is? But they're often needed to help you deliver your baby easier. If you've heard the word and you're wondering what it's all about, we've rounded up everything you need to know, with expert guidance from Melanie Every of the Royal College of Midwives.

What is an Episiotomy?

An episiotomy is when your midwife makes a cut in your perineum (the area between your vagina and anus) to make the opening of your vagina wider. The cut will be made large enough for your baby to fit through but will be done with extreme precision so not to damage anything permanently.

The idea may seem scary (or just plain unthinkable), but if needed, it could make recovery from birth easier. And believe it or not, an episiotomy used to be a routine part of childbirth, but thankfully for many mums this has changed and it's only used in certain circumstances.

If you do need an episiotomy, you’ll be completely numb down there and won’t feel a thing. Plus it can prevent a tear from happening.

Why is it needed?

Episiotomies are done for loads of reasons. And while there probably isn’t one mum-to-be who would choose to have an episiotomy, it can help your labour along – especially if you’re overtired, your baby needs a helping hand making his grand entrance or it looks like your baby needs more space to be delivered.

  • You may need an episiotomy to help things along if your baby is breech or premature

  • Your baby's shoulder is stuck behind your pelvic bone (shoulder dystocia)

  • If you have high blood pressure, so you don’t have to push so hard

  • You may also need one if your baby shows any signs of distress (for example if their heart-rate pattern becomes abnormal) and need the delivery to be quicker

  • It can also be a way to make space if ventouse or forceps are needed

  • You may also be completely exhausted from labour, and need a little help to cross the finish line.

Whatever the reason, it’s not your fault. ‘Unfortunately, an episiotomy is one of the things that women can feel badly about after giving birth,’ says Melanie. 'They often feel they’ve failed in some ways, which of course they haven’t.'

How is it done?

Lying down with your feet in stirrups, your perineum will be cleaned with antiseptic and numbed with a local anaesthetic. If you’ve already had an epidural, this may be topped up to completely deaden the area. But either way, you won’t feel a thing. If you do, alert your midwife immediately.

The cut is made with a pair of special scissors or a scalpel and there are two different types of incision that can be done:

  • Midline (median) incision: done vertically. A midline incision is easier to recover from, but there is a higher risk of extending into the anal area which can in some cases lead to faecal incontinence.

  • Mediolateral incision: this is done at an angle and offers the best protection from an extended tear to the anal area. This kind of incision is often more painful and is more difficult to recover from.

Don’t be surprised if your baby is born almost immediately afterwards – this is completely normal for this procedure. 

Once your baby has arrived, you’ll be stitched up with a dissolvable thread – saving you a trip back to the hospital to have the stitches removed. This takes around 30 minutes but no doubt you’ll be completely preoccupied by your beautiful baby and will barely think about what’s going on down there.

How long will it take to heal?

You should feel back to normal within about six weeks of giving birth as the perineum tends to heal quickly. It’s very rare that you’ll need anything re-stitched, but if you do then your midwife will advise. You may also experience pain in that area in the months after giving birth which you should discuss with your health visitor or GP if it persists. 

‘A woman’s general health and her level of hygiene has a great effect on how well an episiotomy heals,’ says Melanie. ‘A good after-care routine should include a healthy, balanced diet and regular bathing.’ Changing your maternity pads regularly will help to lower the risk of infection.

Don’t overtire yourself – your body has gone through a lot so exercise and sex will go out for the window for the time being. Stay in your slouchy clothes, forget about doing your make-up and let your partner do the housework. Give yourself time to heal and enjoy this precious time with your newborn.

Will there be a scar? 

For some women, they can experience scarring after an episiotomy. This scar tissue can be raised from the skin or be itchy. If the scar is causing you any issues or discomfort, it's important to seek help from your doctor.

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