Pregnancy & Baby 

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Episiotomy – the nasty cut?

In the last stage of labour, some women find they have a problem getting the baby’s head out. Christine Hill on whether it’s better to have an episiotomy rather than tear

When a baby is born, the head has to be pushed through the birth canal and out through the entrance of the vagina. The baby’s head will stretch the opening of the vagina in a similar way to a sweater with a tight neck when you pull it on over your head. The muscles around the vaginal opening may not be able to stretch quite enough, so they tear slightly. This is normal and occurs in about three-quarters of births.

In order to stop uncontrolled and severe tearing, or to allow a baby to be born quickly, the midwife or obstetrician can make a small cut to the side of the vaginal opening, widening it to allow the baby’s head to pass through. This is called an episiotomy.

Why the fuss?

Twenty years or so ago, nearly all women had an episiotomy, sometimes in a hurry and without enough pain relief. Then people began to question their necessity, especially as small tears were found to heal more quickly than episiotomies. As the pendulum of opinion swung to the other extreme, some women came to regard the cut as a physical attack by male obstetricians on vulnerable women and some hospitals even said they never did episiotomies.

A more balanced approach has been to list the occasions when an episiotomy is helpful to baby and mother.

The most common situations would be:

• The baby is in a slightly awkward position, with the wide part of his head presenting first or with his arm up by his head.
• The baby is tired (a euphemism for not getting enough oxygen) and needs to be delivered quickly.
• The baby needs an assisted delivery by forceps or when a Ventouse extraction is performed.
• The woman’s pelvic floor muscles are less elastic than usual, so that it’s clear they can’t stretch enough to allow the baby to pass through and a serious tear backwards is likely.

Although small tears are acceptable, a major tear backwards into the rectum (third degree tear) can create serious complications and is obviously something best prevented.

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