What is an episiotomy and why is it done during a normal delivery

The procedure involves enlarging the vaginal opening to ease the delivery process.

If you are pregnant and your due date is just around the corner, you are probably worrying about the birthing process. One of the things that comes with giving birth naturally is an episiotomy or enlargement of the vaginal opening to ease the birthing process. Dr K K Panicker, consultant obstetrics & gynaecology, SevenHills Hospital talks about the procedure and why it is required.

What is an episiotomy?

An episiotomy is an incision over perineum (the part of skin between the vagina and anal opening) during labor to widen the introitus or the vaginal opening. This is done for easy delivery, to protect the perineum and at times the baby (particularly in the case of premature births) from injury.

Under what circumstances is this procedure required?

There are a number of situations that require us to do an episiotomy, but some of the most pressing causes are:

• If the baby is mal-positioned, is in the breech position or is large and heavy
• First time deliveries, where a woman has had prolonged labour, has a thick and rigid perineum
• If the woman has to have an instrumental delivery (like a vacuum or forceps delivery)

What can go wrong while performing an episiotomy?

While performing the episiotomy, the cut can inadvertently extend and may injure the anal sphincter (a circular muscle that controls the passing of motion and opening and closing of the anus) and rectum. This may result in a little excessive bleeding. In some cases it may also lead to vulvar hematoma (bleeding into a part of the outer structures of a woman's genitalia) more so in the vulnerable patients.

How long does an episiotomy take to heal?

It will take about seven to ten days to heal. A woman may experience some rawness for a few days after the wound has healed.

What precaution should a woman take after the procedure?

There are no special precautions that a woman needs to take after an episiotomy, but it is essential that she keep the area clean, especially after visiting the washroom. If cleaning the area is difficult or painful, she may sit in a tub with warm water and a cap full of liquid antiseptic solution or disinfectant (this will be quite soothing and keep area clean too). Here are ways to help you heal the episiotomy scar post delivery.

Can a woman choose not to have an episiotomy? What other options does she have?

The choice to have, or not to have episiotomy should be left to the consulting doctor as he/she will be better equipped to understand the necessity of the procedure and have the patient's best interest in mind. Not having an episiotomy may lead to perineal tears, weakness of the perineum and widening of the introitus.

Finally, delivering a baby can be a scary thought, but it is best a woman talks to her treating physician before the delivery, in order to quell her fears. Remember there are no stupid questions and being calm through the process of birthing is the best way to have a safe and successful delivery. (Read: Have scary thoughts of going into labour? Here's what you need to know)

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