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Episiotomy – Perineal Cut During Childbirth

An episiotomy is a surgical incision made in the perineum during childbirth to widen the birth canal and reduce the risk of severe tearing of the surrounding tissue.

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Things worth knowing about "Episiotomy"

An episiotomy is a surgical incision made in the perineum during childbirth to widen the birth canal and reduce the risk of severe tearing of the surrounding tissue.

What is an Episiotomy?

An episiotomy (also known as a perineal incision or surgical cut) is a deliberate surgical cut made in the perineum – the tissue between the vaginal opening and the anus – during childbirth. The purpose of this procedure is to enlarge the birth canal, facilitate delivery, and, in selected situations, prevent severe uncontrolled perineal tears.

The procedure is performed by a midwife or an obstetrician and has historically been one of the most commonly performed obstetric interventions worldwide. However, current clinical guidelines no longer recommend its routine use; it is now reserved for specific medical indications only.

Types of Episiotomy

Mediolateral episiotomy: The incision is made at a diagonal angle toward the side – the most common type in Europe, associated with a lower risk of damage to the anal sphincter.
Median (midline) episiotomy: The incision is made straight back along the midline – associated with less postoperative pain but a higher risk of deep perineal injury extending to the anal sphincter or rectum.

Indications

An episiotomy is now only recommended in specific clinical situations, including:

Fetal distress requiring rapid delivery
Instrumental delivery (e.g., vacuum extraction or forceps delivery)
Breech presentation
Imminent severe perineal tear (third or fourth degree) with a narrow birth canal
Shoulder dystocia (when the infant's shoulder becomes impacted behind the pubic bone)

Procedure

The incision is typically made under local anesthesia, unless an epidural (regional anesthesia) is already in place. The cut is performed at the height of a contraction when the perineal tissue is maximally stretched. After delivery of the baby and the placenta, the incision is closed with sutures in multiple layers.

Wound Healing and Aftercare

Recovery usually takes two to four weeks. During this period, pain, swelling, and a feeling of tension in the perineal area are common. The following measures support healing:

Regular wound checks by a midwife or doctor
Careful perineal hygiene and cleansing
Sitz baths with antiseptic or healing-supportive additives
Ice packs or cooling pads to reduce swelling
Pain relief medication as recommended by a healthcare provider
Pelvic floor exercises to support recovery

Possible Complications

As with any surgical procedure, episiotomy carries some risks, including:

Wound infection or impaired wound healing
Postpartum bleeding
Painful intercourse (dyspareunia) after recovery
Scar tissue formation
In rare cases: injury to the anal sphincter or rectum (third- or fourth-degree laceration)

Episiotomy vs. Spontaneous Perineal Tear

Research has shown that routine episiotomy does not produce better outcomes than a spontaneous perineal tear. The World Health Organization (WHO) and national obstetric societies therefore recommend a restrictive approach – meaning the procedure should only be performed when there is a clear clinical need. An episiotomy does not prevent all types of perineal tears and cannot eliminate the risk of more severe injuries.

References

World Health Organization (WHO) – WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. Geneva: WHO; 2018.
Carroli G, Mignini L. – Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD000081.
American College of Obstetricians and Gynecologists (ACOG) – Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol. 2018;132(3):e87-e102.

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