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Ask Dr Arun

1 – Episiotomy is a part of a protocol in a Normal Delivery, especially when it’s a first delivery. It is occasionally required in multi delivery too.
2 - Episiotomy is a surgical cut in the perineum as the baby is born to increase the opening of the vagina.
Episiotomy is basically a preventive procedure. In 25 percent of the patients who are delivering for the first time, if episiotomy is not given as a preventive measure there is a distinct chance that the perineum gets torn haphazardly while the baby comes out. When it happens the tear may involve the anal sphincter as well as the rectal mucosa.

Episiotomy prevents this complicated tear. With episiotomy the doctors cut the perineum away from the anal opening and it’s a clean cut. It’s a controlled one. Episiotomy is given after the local anesthesia and hence it is not painful. It’s sutured in layers and gets healed fast without any residual permanent change.

I am aware that now there is emphasis in avoiding episiotomy. But after having conducted more than 5000 deliveries in a rural Indian set up, I am of opinion that as a preventive procedure its value stands forever and those who do away with it, they must have sufficient clinical acumen to know where to wave it. As a general rule no one should take episiotomy out of protocol of a normal delivery at least in those who are delivering their first baby.

The so called assumed side effects of episiotomy like pain, extension of the healing period, increased bowel incontinence and pain during intercourse in my opinion are exaggerated and I see all of them paradoxically in those who have delivered in home in surrounding Indian villages! (How they wish that they had delivered in a well-equipped hospital!)
None I have encountered in hospital deliveries when episiotomy is used as a preventive procedure.

In patients who deliver with epidural anesthesia there is invariably a vacuum pump or outlet forceps application. And when any such intervention is required, episiotomy has to be given.

One last point is worth mentioning. When I asked the pointed question to my patients who were bearing down, tired and fatigued after nearly twelve hours of labor pains in their first delivery, whether they would like to deliver a few minutes earlier with episiotomy or would they prefer few more pains, all urged me to go ahead with episiotomy!
Episiotomy does reduce the total duration of labor and that is a most anticipated relief for the woman giving labor pains. After all labor pains are supposed to be the most painful episodes, the only contenders of competition are the dental pains! No one should be so overzealous to ban episiotomy, which is a time-tested companion of a woman in her most agonizing sufferings.


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