What is an episiotomy?

Indications and Procedures

An episiotomy is performed to enlarge the vaginal opening and ease the delivery of a baby during
childbirth. While not a routine procedure, some circumstances that indicate the need for an episiotomy include macrosomia (large fetal size), rapid delivery, breech delivery, and presentation of the baby with face to the front of the birth canal, all of which prevent the perineum (the area between the vagina and the anus) from stretching rapidly enough to prevent tearing. Scarring from vaginal surgeries also limits the ability of the vagina to expand.

During the procedure, a local anesthetic is injected into the perineum. The provider uses straight-bladed blunt scissors to snip the tissue between the vagina and anus diagonally, avoiding the anal sphincter muscle and preventing tearing into the anal sphincter. After delivery, the incision is carefully stitched together, along with any minor tears in the birth canal. Delivery by a nurse midwife as opposed to a private obstetrician is far less likely to result in an episiotomy, as episiotomies are not done routinely by nurse midwives. Furthermore, with a nurse midwife, techniques such as vaginal-perineal massage with warm oil are employed to help stretch the perineum and avoid the need for episiotomy.

Uses and Complications

The birth canal has very limited space to accommodate an infant, and situations such as feetfirst or face-forward presentation can lead to compression of the umbilical cord and interruption of the oxygen supply to the baby, or even to potential crushing of the infant. An episiotomy can facilitate a rapid delivery in these circumstances, thereby preventing serious injury to the infant. Failure of the perineum to stretch sufficiently to accommodate the child can result in severe, irregular tears of the vagina and even of the anal sphincter muscles. Ragged tears are very difficult to repair surgically and are much more prone to infection. Tearing of the anal sphincter could lead to permanent incontinence. The easily repaired incisions of episiotomy eliminate these potential difficulties.

Healing of the incisions is rapid and straightforward, but the area may itch and be somewhat painful for a few weeks. Painkilling drugs may be prescribed, and ice packs can be used to alleviate pain. Women who do not desire episiotomies and have controlled, problem-free deliveries may try to stretch the perineum gradually by massaging it with warm oil during the delivery. While in the past, episiotomies were considered a routine part of delivery, they are now done less commonly, only as necessitated for conditions like those indicated above. Additionally, maternal satisfaction is increasing as episiotomies are being done more when they are necessary and to a lesser extent when they are avoidable.

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