At the time of vaginal delivery, the opening to the uterus, called the cervix, dilates to allow the baby to pass from the uterus into the vagina. The vagina is a muscular tube that expands to accommodate the head and shoulders of the baby while uterine contractions continue to push the baby outward.
Occasionally, the vaginal opening is too narrow to allow the baby to be born without tearing the vagina. When this risk is present, a procedure called an episiotomy may be performed.
During an episiotomy, a doctor makes an incision at the bottom of the vagina. This enlarges the vaginal opening to prevent vaginal tears as the baby's head is delivered. Following delivery, the incision is then stitched closed for healing.
The incision, which can be done at a 90 degree angle from the vulva towards the anus or at an angle from the posterior end of the vulva (medio-lateral episiotomy), is performed under local anesthetic (pudendal anesthesia), and is sutured closed after delivery.
Episiotomy can be avoided by 'birth canal widening' performed before the start of labour and achieving a 10 cm opening to the birth canal so the baby's head can pass through easily.
Episiotomy Procedure (Animation) http://www.pregnancyvideo.net/episiotomy-vaginal-birth
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