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Episiotomy: Why, when and how

Is an episiotomy always necessary?
An episiotomy is the incision or cut that is made on the perineum to increase the size of the opening, thereby facilitating delivery. It is not always necessary. To do or not to do an episiotomy is one of the most important (and quick) decisions the person assisting delivery has to make.

An episiotomy will prevent a perineal and/or vaginal tear and also hasten delivery. It is also believed to prevent future urinary problems, to some extent, by protecting the pelvic support muscles from damage that may be caused by over­stretching.

It is, however, unnecessary to perform an episiotomy where progress in the second stage is smooth and the risk of a tear is deemed minimal.
It is impossible to be precise every time in this assessment and sometimes the judgement is wrong and a tear occurs where it was least expected.


It is said an episiotomy is mandatory in the first pregnancy (vaginal delivery). Is this true?
It is never wise to be dogmatic in these things.
The truth is, many, if not most first-timers will have an episiotomy, but there is a significant minority where this will be correctly judged to be unnecessary. It is up to the midwife or doctors assisting in the delivery to make that decision rather than hide behind a blanket policy. By the same token, some moth­ers who have had a previous baby may require an episiotomy.

With forceps delivery, an episiotomy is necessary, regard­less of the number of past deliveries. This is because the risk of a tear is quite high with this method of instrumental delivery.

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