What is an episiotomy?

Episiotomy is a small surgical cut in the perineum (the muscular area between your vagina and back passage). It is done during crowning of your baby’s head to enlarge the vagina opening to help to delivery your baby. However, it is not routinely done anymore due to several reasons.

How is an episiotomy done?

If you do need an episiotomy, a local anaesthetic will be injected at your perineum before the cut. However, you may not need a local anaesthetic if you have already had an epidural for pain relief in labour. There are two types of episiotomy:

  • The mediolateral cut is angled down away from the vagina and the perineum, into the muscle and  slants away from the back passage (rectum
  • The midline cut is done by cutting straight down into the perineum towards the back passage

When is an episiotomy necessary?

  • When a baby’s head is too big for your vaginal opening
  • When the baby need to be delivered imminently due to fetal distress
  • When you need a forceps or vacuum assisted delivery
  • When your baby’s shoulder gets stuck at the birth canal during delivery (shoulder dystocia)
  • The baby is in a breech presentation

What are the possible complications of an episiotomy?

  • Infections
  • Swelling
  • Persistent pain
  • Bleeding
  • Bruising
  • Painful scar
  • Narrowing of vaginal opening due to scarring
  • Incontinence in the future
  • Increased risk of third and fourth degree tears


How can I prevent having an episiotomy?

  • Healthy diet and good nutrition so that the perineal skin can stretch more easily
  • Exercise for your pelvic floor muscle (Kegel exercise)
  • Perineal massage weeks before your due date
  • Warm compression and support during labour
  • Delivery in standing or squatting position
  • Perineal support by your birth attendant

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How could I reduce the pain from an episiotomy and tear?

  • Use cold packs on the perineum
  • Take a sitz bath
  • There are some oral medication you could take to reduce the swelling and pain at the perineum.   Consult your doctor before taking these medications
  • Use lubricant such as KY Jelly when you have sexual intercourse


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