Episiotomy – the nasty cut?

You shouldn’t feel anything. If you need an episiotomy, you should be given a local anaesthetic or your epidural will be topped up. Incredible as it may sound, most women who have just given birth don’t know whether they have had a tear, an episiotomy or have an intact perineum.

And afterwards?

Most women will need a few stitches after they have given birth, whether they have torn or had an episiotomy. The stitching is performed by the person who delivered the baby, so it might be a midwife or an obstetrician. The mother is given a local anaesthetic. If she’s already had an epidural, it will be topped up as necessary. The mother will lie on her back with her legs up in stirrups, so the person who is stitching can see what they are doing. The stitches don’t have to be taken out later; they dissolve of their own accord over the next couple of weeks.

They can sometimes be pretty uncomfortable, but they shouldn’t be a major problem. Luckily, the pelvic floor muscles have an extremely good blood supply, so everything heals very quickly. It helps the healing if you do the pelvic floor exercises that you were taught in your antenatal classes. The good news is that 97% of women are able to have sex six weeks later. Whether they want to is another story.

So what’s worse, a tear or an episiotomy?

In my experience there isn’t much in it, as long as a tear back into the rectum (a third degree tear) is avoided.

Is there any way of avoiding either?

Some people advocate massaging the perineum with almond oil during pregnancy but, as far as I know, there is no hard evidence to show that this does much. Unfair as life is, some women are born with less elastic pelvic floor muscles and there isn’t anything you can do to change this.

Neither has any study shown that the position you adopt when you deliver your baby makes a difference. Nothing you do when you are pregnant is going to have an effect on the position of your baby’s head at birth, the shape of your pelvis or the amount of elasticity in your skin and muscles around your vaginal entrance.