What is an episiotomy?
This is a cut into your perineum usually at the right side of the opening of your vagina. It makes it easier for you to deliver your baby’s head and body through your birth canal. It can also help to avoid tears, which could otherwise affect your anus. Having an episiotomy used to be routine practice, but this is no longer the case. Now, we only do an episiotomy with good reason. It is still very common, being done for about one in five births.
What has gone wrong?
We divide the reasons for giving you an episiotomy into three groups:
- Reasons connected with the mother
- Reasons connected with the baby
- Assisted deliveries
Reasons connected with the mother
Delay in delivering your baby’s head - Sometimes, despite pushing, your baby’s head will not deliver through your birth canal. An episiotomy will make your birth canal wider.
Avoiding a large tear - If it looks like you are in danger of a large tear an episiotomy is done. A clean cut is easier to repair than a large tear. It will also help avoid a tear that might otherwise affect your anal sphincter.
Avoiding a repeat bad tear - If you have torn during a previous birth and there is a lot of scarring we will usually recommend an episiotomy to prevent a repeat bad tear.
Tiredness - After a long, exhausting labour you may be too tired to push. An episiotomy can make the last part of delivery easier.
Reasons connected with the baby
Distressed baby - If fetal monitoring shows your baby is becoming distressed near the end of labour we may do an episiotomy. This will help deliver your baby as quickly as possible.
Breech presentation - If your baby delivers bottom first this is a breech presentation. We do an episiotomy when your baby’s bottom is being delivered so that your baby’s head and shoulders come out more easily. We may also do an episiotomy for twin deliveries if your second twin is breeched or distressed.
Stuck shoulders - If your baby’s head delivers but the shoulders become stuck this is called shoulder dystocia. It is more likely to occur if your baby is larger than average or if you suffer from diabetes in pregnancy. We do an episiotomy or occasionally make one bigger to help deliver the rest of the baby.
Preterm babies - If you are giving birth before your due date then you have a preterm baby. In the past mothers of preterm babies were routinely given an episiotomy to reduce pressure on the baby’s head to prevent fetal distress. Although this is no longer the case, if your delivery is takes too long and your baby is becoming distressed, an episiotomy may be made sooner than for a full term baby.
Delivery with forceps - We deliver some babies with the help of forceps. The opening of your birth canal will need to be wider to contain both your baby’s head and the forceps. We widen your vaginal opening with an episiotomy when the top of your baby’s head is visible.
Delivery with suction - An assisted delivery with suction is called a ventouse delivery. You may not need an episiotomy as the suction cup does not need as much space in the birth canal as forceps. If you are having an assisted delivery because of other reasons, such as fetal distress or because you are too tired to push, then you may still need an episiotomy.
The most common reason for having an episiotomy is because your vagina will not stretch enough to deliver your baby’s head. This is often the case for first time mothers. Your baby’s head may be too large for you, putting you in danger of a large tear.
We do an episiotomy to widen your birth canal. The aim is to deliver your baby safely and make sure you come to no harm.
An episiotomy can make delivery easier so that you and your baby avoid undue trauma or distress. It can help avoid large tears, which can be more difficult to repair than a cut.
Are there any alternatives?
If you are offered an episiotomy, it is felt to be the safest way to help delivery for you and your baby. Discuss why you may need an episiotomy with your obstetrician.