Episiotomy

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A cut (made with scissors) in the perineal tissues at the time of birth.

When is it necessary?

• To protect the premature baby's head from undue pressure during birth.
• To allow more space for the application of forceps.
• To protect the baby's head if the perineum is tight and unyielding or is delaying the birth of the baby.
• To speed up second stage.

How is it done?
The mother is asked to lie back so that a clear view of the perineum can be obtained.

• Local anaesthetic is injected in several places close to where the tissues will be cut.
• If the cut is made when the skin is numb from stretching, then no anaesthesia may be needed until stitching begins.
• When the head is crowning, the doctor or midwife makes a surgical cut, using scissors, from the base of the vagina either out to the side (lateral) or down towards the anus (midline). Occasionally a J-shaped incision is made, to the side.
• Dissolving stitches are used which disappear within 1-2 weeks.

Effects on the mother
Advantages:

	1.	An episiotomy may speed up labour by removing the need to wait for tissues and skin to stretch during second stage.
	2.	An episiotomy may be preferable to an uncontrolled tear if the birth is fast or the tissues are very tight.

Disadvantages:

	1.	An episiotomy done before the perineal area has fully stretched will involve cutting much tissue and a significant blood loss as a consequence.
	2.	Episiotomies frequently tear further, causing a bigger wound. If extensive, this tearing can involve the anus and make extensive surgical repair necessary. Involvement of the anal sphincter can lead to weakness and problems with incontinence.
	3.	An episiotomy takes longer to heal and is more painful than a tear, as muscle tissue is involved in an episiotomy. Tears usually involve only skin and superficial tissue, and therefore heal faster.
	4.	Healing can take months for some women. Sexual difficulties and general pain and discomfort may be felt until healing is complete. Further repair work may be necessary.
	5.	Having a sore perineum and stitches that require care can interfere with the ability to take care of a baby in the first days post-partum.

Effects on the baby
Advantages:

	1.	Shortens second stage
	2.	Prevents undue pressure on the head of a premature baby.

Disadvantages:

1.

A sore and tender perineum can make it more difficult for the mother to care for the baby after the birth.