Episiotomies

We all hope to avoid an episiotomy during labour, but sometimes it is necessary. We take a look at what’s involved

An episiotomy is a cut made through your perineum (the area between your vagina and the anus) to make your vaginal opening large enough for your baby to be born. It is also something a lot of us hope to avoid during labour.

‘Unfortunately, an episiotomy is one of the things that women can feel badly about after giving birth. They often feel they’ve failed in some ways, which of course they haven’t,’ says Melanie Every of the Royal College of Midwives.

When it’s needed

* To speed up delivery when your baby’s head is crowning and he’s showing signs of distress
* Before a forceps or ventouse delivery
* During a breech delivery or a premature birth
* So women with heart disease or high blood pressure don’t have to push so hard
* To help delivery if your perineum can’t stretch enough to let your baby out
* To speed up delivery if you’re very tired

What it involves

You’ll be asked to lie on your back with your feet up in stirrups. The area will be cleaned with antiseptic and, if you’ve already been given an epidural, it may be topped up to deaden the area. Otherwise, you’ll be given some local anaesthetic to numb your perineum.

The actual cut is usually made with a pair of special episiotomy scissors or a scalpel. It’s normally done at a slight angle and your baby is likely to be born almost immediately afterwards. Usually you won’t feel any pain at all. If you do, tell your midwife immediately.

Stitching time

Once your baby is born and your placenta has been delivered, your cut will need stitching. The thread used is absorbable, so it won’t need removing. The time it takes varies, but it shouldn’t take more than 30 minutes. Lots of women are so absorbed in getting to know their new baby, they don’t remember being stitched up at all!

What about afterwards?

You can help your perineum to heal quickly. ‘A woman’s general health and her level of hygiene has a great affect on how well an episiotomy heals,’ says Melanie. A good after-care routine should include a healthy, balanced diet and regular bathing.’ You can also help by changing your maternity pads regularly to lower the risk of infection.

Occasionally, one or two stitches may feel too tight afterwards, but your midwife can help by simply snipping them away. Most women feel back to normal by their six-week check-up, but if you do have any pain do mention it to your GP. If your stitches aren’t healing as well as they should, or they’re infected, you may need to be restitched, although this is rare.