The fear of rips and tears from childbirth is a very common one, but did you know that sometimes doctors actually lend nature a hand and manually cut women down there? It’s called an episiotomy and here’s what you need to know about it.
What it is exactly
Thanks to the amazing cervical dilation process during childbirth, the area between the vagina and anus (called the perineum) stretches which helps make it physically possible for something the size of a pineapple to come out of your small opening. With an episiotomy though, a local anaesthetic will be given (if the mother hasn’t already had an epidural), and a doctor or midwife will then make a small surgical cut to the perineum to make it easier and faster for the baby to be delivered.
Why they do it
The main reasons an episiotomy will be performed is if the baby is in distress and needs to be delivered quickly to prevent birth defects or being stillborn, or the mother herself is at risk of heart failure or another serious health issue. You’re also more likely to have one if:
- It’s your first birth
- Forceps are being used
- Your baby is very large
- The baby is in a breech position
- You have an epidural
- Your labour is long and you’re extremely weak and exhausted
- You give birth lying on your back (particularly if legs are in stirrups)
- You have a private obstetrician or give birth in a private hospital
The great snip debate
In previous decades (between 1940 and 1980) episiotomies became a very popular routine procedure with claims that it prevented long, painful labours and other benefits such as fewer lacerations to the perineum and protecting the baby’s head from trauma. In 1979 63% of all births in the US involved an episiotomy, with the UK and Australia also heavily favouring the snip.
After studies were conducted in the 80s however, many believed that the procedure did more harm than good with reports of pelvic floor weakness, painful intercourse after birth, perineal pain and trauma suffered by the mother. International health bodies therefore now advocate only performing an episiotomy when necessary, rather than making it routine.
Despite this, the procedure is still performed quite widely in Australia, particularly if you give birth privately. In NSW for example, the average rate is 26.3% in private hospitals and 14% in public, although studies show that 5-10% is a preferred amount.
The recovery process
Some believe that an episiotomy is more painful than a natural tear and leads to greater blood loss and a slower recovery, however this is not necessarily the case for all so don’t be afraid if you end up having one. Remember that for women in a high risk category for birth the procedure can literally be life-saving.
After you’ve given birth, if you’ve had an incision they will stitch up the cut which stops the bleeding, using dissolving stitches so you don’t need to go back to hospital. It’s normal to feel pain around the cut for a few weeks after birth, especially when walking or sitting, so you should avoid doing anything too physical. Going to the toilet might sting a bit too, but after a month or so the wound should be completely healed.
How to prevent one
Sudden complications can occur in any birth, regardless of an easy pregnancy, so you never know when you might need an episiotomy. There are however a few common factors which might decrease your chances of having the procedure which include:
- It being your second or subsequent baby
- Having a relaxed pelvic floor
- Giving birth on your side or upright
- Massaging the perineum in the late stages of pregnancy
- Birthing the baby’s head slowly without excessive pushing
Talk to your doctor
If you want to know more about having an episiotomy it’s best to discuss the procedure with your doctor during your pregnancy so you’re fully informed and know what to expect in the event you might need one. Also be aware that if you do need one your consent should be required prior to it being undertaken, as with any other surgical procedure.
Did you experience an episiotomy during childbirth?