Why is an episiotomy performed?

Episiotomy is a surgical incision made in the perineum, the area between the vagina and anus, during childbirth. It is performed to enlarge the vaginal opening and facilitate the delivery of the baby, especially in cases where the baby is large, the mother's perineum is tight or rigid, or when there is a need for assisted delivery using instruments like forceps or vacuum extraction.

Reasons for performing an episiotomy include:

1. Prevention of Perineal Tearing: Episiotomy can prevent uncontrolled tearing of the perineum, which can extend into the rectum and cause significant damage to the surrounding muscles and tissues. A controlled surgical cut allows for a cleaner and more manageable repair.

2. Facilitating Delivery: In certain situations, an episiotomy may be necessary to create more space for the baby's head to emerge, reducing the risk of prolonged labor and associated complications for both the mother and the baby.

3. Reducing the Risk of Pelvic Floor Injury: Episiotomy can help protect the pelvic floor muscles, which support the uterus, bladder, and rectum. Excessive stretching or tearing during childbirth can weaken these muscles, leading to potential long-term complications such as incontinence or pelvic organ prolapse.

4. Assisted Deliveries: Episiotomy is often performed in cases where instrumental assistance like forceps or a vacuum extractor is required for the delivery. These instruments may put extra pressure on the perineal area, making an episiotomy necessary to prevent severe lacerations.

5. Breech Births: Episiotomies are more likely to be performed during breech births, where the baby's feet or buttocks present first. This is because breech deliveries require more room and maneuvering, which can increase the risk of perineal tearing.

It's important to note that episiotomies are not routinely performed in all deliveries, and the decision to make an incision is made by the healthcare provider based on the specific circumstances and conditions during labor. Episiotomy rates vary widely across regions and providers and have seen a decline in recent years due to a focus on natural childbirth and interventions that preserve the integrity of the perineal area.