Chapter 19: Advanced skills for pregnancy and birth
An episiotomy means cutting the opening of the vagina to make it larger for the
baby to come through. Episiotomies are rarely needed and are done much too often.
Only do an episiotomy if the baby is already in the vagina and must be born
quickly because of a medical emergency. An episiotomy may be necessary when:
• the baby is breech.
• the baby is about to be born, and there is a gush of blood from the vagina
(which may mean the placenta has come off the womb wall). This baby must
be born very quickly or she could die.
• the cord has prolapsed (see page 176).
• the mother has had female genital cutting, and heavy scars may prevent the
vagina from stretching open for the baby. If you know how, you can cut the
scar (see page 367). If you do not know how to cut this scar, you may need to
do an episiotomy.
WAR NING! Cutting an episiotomy has many risks:
• The cut can become infected.
• T he cut can go through a blood vessel and cause
• T he cut can be very painful for the mother after the birth.
This can make it harder for her to care for her baby.
• E ven a small cut can continue to tear. In the worst case, it
can tear through the rectum (anus).
• You can accidentally cut the baby.
Episiotomies do not heal more easily than tears. Only do an
episiotomy to save the life or health of a baby or mother.
How to do an episiotomy
1. Wash your hands well (see page 53)
and put on sterile gloves.
2. Wait until the vagina is bulging open
and you can see the baby’s head
A Book for Midwives (2010)