Episiotomy is rarely justified, except in cases of foetal distress necessitating immediate delivery. — Elizabeth Davis, author of Heart & Hands: A Midwives Guide to Pregnancy & Birth
An episiotomy is a cut that is made in the perineum with scissors to enlarge the vaginal opening.
Use of epidurals increases the chances of an instrumental birth by vacuum extraction or forceps, which often means an episiotomy is performed.
Natural tearing heals better and quicker and hurts less. Episiotomies are often done ‘just in case’ rather than for a valid reason.
If women can feel her perineum (no epidural), relaxes her mouth, can move around freely and is gently supported through second stage, her chance of tearing is very low.
An episiotomy is performed as the baby’s head stretches the perineum. A local anesthetic may be injected into the area beforehand. The cut is approximately 2 – 4 cam long and is made through the skin and muscle of the perineum, either at an angle or down the midline. The cut is sewn up after birth.
Many doctors base their decision on whether to perform an episiotomy on the idea that it prevents damage to the birth canal. Research does not support this. Women are not always asked for consent before an episotomy is performed.
22.66% Private Hospital (NSW)
10.36% Public Hospital (NSW)
(Source: NSW Mothers & Babies Report 2009)
Check your local hospital episiotomy rates here in our Birth Services Revealed.
- Forceps assisted birth
- Vacuum assisted birth
- Baby in distress and needs to be born quickly
- To help protect the head of a very premature baby
- Mothers is distressed or very tired
- 2nd stage is taking to long, (this varies between care provider)
It is normal for the second stage of labour, to last for anything up to three hours.
When a woman is able to move around in her labour, when she is able to use upright positions for second stage and when she is allowed to take her time and not encouraged to push forcefully, episiotomies are rarely needed.
Different maternity units have different episiotomy rates. Homebirth have the lowest followed by birth centers, private obstetricians have the worst. You can check the episiotomy rates of your local hospital or birth service on our Birth Services Revealed database here.
If you are not sure why an episiotomy is being suggested, ask, “Am I OK? Is my baby OK?” If the answer is yes, then tell them not to cut you.
If the perineum is tight, warm compresses can help bring blood to the tissue so they can stretch more easily, making episiotomy often avoidable.
Natural tearing is better than an episiotomy. A natural tear is more superficial and usually does not go through the muscle layer and heals better.
How to avoid an episiotomy & protect your perineum
- Choose a care provider with a low or zero episiotomy rate.
- Increase your conscious awareness of the muscles in your perineum during pregnancy by practicing Kegel exercies.
- Avoid lithotomy position (flat on your back) for birth or pulling back your legs which tightens the perineum.
- Do not force pushing — learn how to breathe your baby out. Techniques such as little puffs like you are blowing out a candle when the head is crowning will help protect your perineum.
- Reach down and feel your baby’s head as it crowns and emerges from your body. Natural feedback will help guide you.
- Feel yourself opening and allow your body to do this.
About half an hour into the push of my life, my obstetrician arrived in gumboots looking like he was going out for a spot of fishing. He was coaxing me to push but after a while he said, ‘I think we might need a little assistance here’. I clearly remembered the look my midwife gave him. I wasn’t asked if I wanted an episiotomy, it was just done. I didn’t even realise I’d had one until I was about to leave hospital and another midwife checked my stitches and told me that indeed I’d been cut. — (Katrina O’Brien, Birth Stories, Allen & Unwin, 2005)
With episiotomy rates as high as they are in some hospitals when do we start calling it female genital mutilation? – (Justine)
I was not going to have an episiotomy or a 2nd degree tear, so I learnt everything I could about breathing my baby out, and it worked, two babies, no tears, no cuts. — (Jen)
After almost three hours off pushing, with no intervention and trying every position in the book I chose to have an episiotomy. I felt it was time for my poor baby to come out after spending so long pushing against my perineum. The next contraction after the episiotomy he come sliding out and was placed up onto my chest where he stayed for more then two hours before any of us moved, it was amazing. — (Chrissy)
Dr B said he would need to use clamps and that the more I pushed the less he would have to pull. So we coordinated our efforts and while I pushed, he cut me (DP heard the snip), stuck the salad tongs in and grabbed Bub’s head. I pushed, screamed and hollered, and he pulled (turning Bub at the same time) and shortly thereafter Bub’s head emerged. Read more.
Outcomes of routine episiotomy: a systematic review.
Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse. Pain with intercourse was more common among women with episiotomy.
K Hartmann et al (2005) Journal of American Medical Association.
Check your local hospital episiotomy rates here in our Birth Services Revealed database.
HIGHEST EPISIOTOMY RATE IN NSW (2009)
Goulburn Base 35.7%
HIGHEST 3rd or 4th DEGREE TEAR RATE IN NSW (2009)
St. George 3.6%
(Source: NSW Mothers & Babies Report 2009)
Check your local hospital episiotomy and intact perineum/tear rates here in our Birth Services Revealed.