Is it necessary to have an episiotomy during a vaginal birth?

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The article was professionally consulted by Specialist Doctor II Bui Minh Phuc - Department of Obstetrics and Gynecology - Vinmec Ha Long International Hospital. Doctor has more than 18 years working in the field of obstetrics and gynecology.
An episiotomy is a surgical procedure that actively opens the vaginal opening, to make it easier and quicker for the baby to come out. At the same time, avoid complications such as obstetric trauma, asphyxia, or perineal tear that do not actively affect both mother and baby.

1. Perineum

The perineum is a part of a woman's genitals and is 3-5cm long. The perineum is composed of 3 layers including:
Deep layer: there is anal levator muscle and amputated sitting muscle surrounded by two fascia leaves of the deep perineum; Shallow layer: there are 5 muscles; Middle layer: includes urethral sphincter and deep transverse muscle. The perineum has the function of protecting and supporting organs in the pelvic region such as the vagina, uterus, bladder, rectum, ... and is the place for intercourse to receive sperm. During labor, the perineum dilates, allowing the vagina to expand in preparation for the birth of the baby.

2. Episiotomy

An episiotomy is a procedure that actively opens the vaginal opening so that the baby can easily get out. In addition, it also avoids obstetric complications such as obstetric trauma, asphyxia, involuntary perineal tearing and leaving negative effects on aesthetics, sexual relations and future births.
In addition, in some cases, a natural perineal tear will damage the perineal area. Especially in the tear at the 6 o'clock position, it is easy to damage the anal sphincter and make it difficult to defecate. Pregnant women will often delay defecation due to pain and constipation or other related effects.
Episiotomy is done when the baby's head is peeking out from the vulva. When the vagina is fully open, the woman will be given a local anesthetic, until the contractions are high, a 45-degree cut is made at the 7 or 5 o'clock position, sometimes both. After the baby is born, the doctor will stitch the perineum. The mother will be injected with local anesthetic to relieve pain and sutured with dissolvable sutures after 3 weeks for the muscle layer or the mucosal layer. The skin layer is sewn with nylon thread, after 5-7 days, the thread is cut.
Episiotomy has 4 levels, the level of damage will increase gradually. Depending on each specific case, the doctor will decide which level of incision, to meet favorable conditions for the baby to be born quickly and easily.

3. Subject to have episiotomy

Episiotomy is not necessary for mothers who are easy to give birth or the fetus has a compact body. However, some women have indications for episiotomy, including:
The perineum has poor flexibility, especially for those who have given birth; Pregnant women with vaginitis and edema; The fetal head has a large diameter; The mother's contractions are not strong enough; Pregnant women aged 35 and over; Pregnant women with heart disease or pregnancy toxicity ; Signs of fetal distress appear.

4. Effects of episiotomy

Episiotomy can cause a number of complications such as:
Pain and slow healing: episiotomy is painful and takes longer to heal than a natural tear; Scars: if the scar is large or bad, it may affect the daily activities and sexual relations; Bacterial infections: The perineum in front of the vagina and behind the anus is an area full of bacteria. Therefore, an episiotomy is a wound prone to bacterial invasion. Therefore, pregnant women need to take antibiotics as prescribed by the doctor.

Infection is one of the serious complications. Therefore, women need to take care of the perineum after giving birth carefully, for example:
Wear loose, comfortable clothes, clean underwear; Gentle exercise after birth or do some therapeutic exercises, help blood circulation and reduce swelling of the wound. In addition, limiting vaginal bleeding, creating flexibility for the pelvis and reducing the influence on the bladder and intestines; Clean the intimate area with warm water or diluted salt water about 3 times / day. Wash hands before and after cleaning; Drink enough water and eat a lot of vegetables to avoid constipation; Clean thoroughly after each bowel movement, to avoid stains sticking to the stitches; Do not have sex until the stitches are completely healed, at least 4-6 weeks. In summary, episiotomy is not necessary in all cases of vaginal delivery. The procedure is only performed for difficult births with the aim of giving birth to a safe, healthy baby and avoiding serious harm to the mother.
In order for the whole process of pregnancy and birth to be convenient and safe, and for the baby and mother to be well taken care of after giving birth, you should register for maternity packages at reputable hospitals. At Vinmec International General Hospital, there is a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of highly qualified doctors; Regular examination, early detection of abnormal problems; Maternity package to facilitate the birthing process; Newborns receive comprehensive care.
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