Episiotomy - the "cut" demystify

Once a routine part of childbirth, an episiotomy is now recommended only in selected deliveries.

When you ​​are at full dilatation (10 cm), you are ready to push and deliver your baby. You may wonder — will the doctor make the ‘cut’ at vagina? 

#1 What is an episiotomy?

An episiotomy is also known as the ‘cut’. An episiotomy is a clean cut with scissors under local anaesthetic (so that it is painless!) by the doctor or midwife when the baby’s head is about to deliver known as ‘crowning’. This cut is made into the perineum (skin and muscles between vaginal opening and anus). This will enlarge the outlet, thus facilitating easy birth. ​

#2 Advantages of episiotomy

The biggest pro is to prevent multiple tears, which may occur if your pushing is too fast or your perineum is too short. A bad, ragged tear is difficult to repair, and can have healing problems, especially if the tear extends into the anus (back passage). 

Women in the first pregnancy may need an episiotomy. This is because the perineum is less elastic and thus, less able to stretch to accommodate the delivering head. 

In the past, doctors believe that routine episiotomy prevent urine incontinence and protect the pelvic floor. However, this theory is now debunked and women delivered with no episiotomy, heal better after delivery. I no longer practice routine cut.

Nonetheless, there are still some situations in which a cut may be necessary, especially when: 

• Your baby is in distress and urgent delivery is needed. 

• Your baby's size is big and needs extra space. 

• You need forceps or vacuum assisted delivery. ​ 

• You have a short perineum and risk tearing. 

#3 Types of episiotomy

In general, there are 3 types of episiotomy: 

• Midline: the vertical cut  

• Medio-lateral: the diagonal cut. 

• J-shaped: the cut is first vertical and then to the right. 

The after pain from an episiotomy lasts 5-7 days. This is usually mild and can be relieved by topical anaesthetic gel or oral painkillers. If the episiotomy is extensive, the pain can be managed with cold pads. Sitting device which shapes like doughnut can help relieve pressure on the cut.

#4 Episiotomy aftercare

The aftercare of an episiotomy is important for healing. Daily cleansing with water and frequent changing of soiled sanitary pads help keep the wound clean. 

Dissolvable sutures are used to repair the episiotomy. These stitches do not need to be removed as they will dissolve within 2 weeks. You just need to keep the sutures clean and dry. As the perineal area is richly vascular, the wound heals very well. Passing of urine will not affect the healing. But do avoid the straining of stools. 

As the episiotomy heals, you may feel some mild discomfort. Healing is usually complete after 2 weeks. It is essential that only after your doctor gives you the go-ahead, you can resume your sex life and exercise.  

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