An episiotomy is a medical procedure in which a small incision is cut in the perineum, which is the area between the anus and the vagina, during childbirth. The purpose of an episiotomy is to make the vaginal opening larger to make it easier for a woman to give birth. At one time, the procedure was routine and very common all over the world, but additional research has suggested that this medical intervention is not necessary and can in fact be harmful to the mother.
The rationale behind an episiotomy is that it is better to create a controlled incision with scissors than to allow tearing to occur during delivery. By deliberately making an incision, a doctor can control the depth and angle, making it easier to repair. In a mediolateral incision, the doctor cuts at an angle, while a midline incision runs along the perineum in a direct line from the vagina towards the anus. However, episiotomies actually appear to increase the risk of deep tearing, because the incision essentially starts a small tear which can expand during delivery.
There are also some serious complications associated with this procedure. After the delivery, the site is usually sore and very tender, and it is difficult to urinate or defecate while keeping the wound clean. Episiotomies can also contribute to painful sex and the development of infections, and in some cases they have caused incontinence. All of these risks have made many women extremely wary of the episiotomy.
If a baby appears too large, the perineum is not stretching fully, or tearing has already begun, a doctor may recommend the procedure. Episiotomies are generally not done without the consent of the mother or someone speaking for her, such as a partner or midwife. After the delivery, the tear is sewn up and cleaned, and the woman is provided aftercare instructions which include gentle washing with mild soap, squatting to urinate, and resting in bed to prevent additional tearing.
Women who are strongly opposed to an episiotomy should make sure that their medical teams are aware of this. There are also some steps which can be taken to avoid tearing, including perineal massage, in which the perineum is gently massaged and stretched for several weeks prior to delivery so that it will expand more easily when the baby comes out. However, women should be aware that the best laid birth plan can go awry, and that a doctor may deem an undesirable action medically necessary for the health of the baby or the mother.