The other big snip: Everything you need to know about episiotomy in childbirth

Posted in Birth.

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?

The procedure is called an episiotomy and here’s what you need to know about it.

What is an episiotomy 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 usually much smaller 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.

Doctor delivering baby - feature

Why an episiotomy is done

The main reasons an episiotomy will be performed is if the baby is in distress and needs to be delivered quickly, or the mother herself is at risk of a 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 percent 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 1980s, 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 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 percent in private hospitals and 14 percent in public, although studies show that 5-10 percent is a preferred number.

Woman holding baby after birth - feature

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 to have them removed. 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 an episiotomy

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 or midwife

If you want to know more about having an episiotomy, it’s best to discuss the procedure with your caregiver 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.







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