Episiotomy and perineal tears in Singapore: when a cut is done, healing time and care after birth

An episiotomy is a small cut, usually made sideways, in the skin and muscle between your vagina and anus (the perineum) just before your baby's head is born. In Singapore, KKH's and SGH's patient pages say first-time mothers may need one, to stop the perineum tearing in several directions; the UK's NICE guideline, by contrast, says it should not be routine, so ask your own doctor how often they cut. The cut is closed with dissolvable stitches, and KKH's doctors say the pain usually lasts 2 to 3 days and healing is complete by 6 weeks. For episiotomy stitches care at home, keep the area clean and dry, change pads every 2 to 3 hours, try a salt sitz bath, and see a doctor if there is pus, a foul smell, fever, bleeding from the wound, or pain that keeps getting worse.

This guide covers when and why an episiotomy is done, how it compares with a natural tear, what you can do before birth to lower the risk of a bad tear, and how to look after the stitches.

What an episiotomy is, and why Singapore doctors do one

HealthHub explains that the perineum usually stretches as your baby is born, but it can tear, so the doctor may make a cut to prevent it tearing in all directions as the baby comes out. KKH's doctors, writing in HealthXchange, say a first delivery may require an episiotomy for that reason, because tears can go in many directions and cause a lot of damage. SGH says it may be done at crowning, when your baby's head stretches the perineum, to reduce the risk of uncontrolled tearing, and a KKH leaflet says it is sometimes done to reduce the risk of serious tears into the anus and back passage.

Practice differs between countries: NICE, which sets UK labour guidelines, says not to carry out a routine episiotomy during a spontaneous vaginal birth. The NHS lists when one may be needed: when the baby needs to be born quickly, when forceps or a vacuum are used, or when there is a risk of a tear into the anus. Practice among Singapore doctors varies too, and KKH lists episiotomy among the things to discuss with your doctor at around 36 weeks, so put it in your birth plan and ask how often your obstetrician cuts.

Episiotomy or tear: the degrees

Most first-time mothers have some kind of tear or cut. The NHS says up to 9 in 10 first-time mothers who have a vaginal birth have a tear, graze or episiotomy. The UK's RCOG grades tears by depth:

A KKH leaflet notes that a forceps or vacuum delivery raises your risk of a third- or fourth-degree tear. The RCOG adds a first baby, a baby over 4kg, a long pushing stage and shoulder dystocia. Most of these wounds heal well, but the KKH leaflet notes they can break down, and in severe cases some women have trouble controlling wind or stools, so follow-up matters.

Can you lower your risk of a bad tear?

Some things help, though none guarantee anything.

• Perineal massage: the RCOG says daily perineal massage from 35 weeks, by you or your partner, may reduce your risk of tearing. Check with your doctor first if you have an infection or any bleeding.
• A warm compress: NICE recommends offering a warm wet compress on the perineum once the head is stretching it, until the birth. Ask your midwife.
• Your position: the RCOG says kneeling, all fours or lying on your side may reduce the severity of tearing. Our labour positions guide covers what works in a Singapore delivery room.
• A slow, controlled birth of the head, with your midwife guiding when to push and when to breathe. Our guide on how to push during labour explains this.

The repair

Your obstetrician usually repairs an episiotomy or tear in the third stage, after the placenta is delivered, with dissolvable stitches. The RCOG says a second-degree repair is normally done under local anaesthetic in the room where you gave birth; if you have an epidural, it can be topped up, while deeper tears are repaired in theatre. Nobody needs to take the stitches out; they dissolve by themselves.

Healing time, week by week

Caring for your stitches at home

KKH's discharge advice for an episiotomy wound:

• Keep the wound clean by washing with water, then dry by dabbing gently, after every toilet visit.
• Change sanitary pads every two to three hours.
• For comfort, use cooling-gel pads such as Epikool, lie on your bed or rest on your side every few hours, and avoid sitting for long periods.
• Take the painkillers you were prescribed, on schedule rather than only when it hurts.
• Try a sitz bath: add two teaspoons of salt to cool or lukewarm water in a sitz bath basin, sit so the water touches your perineum, and stay for about 20 minutes, three times a day.

SGH supplies perineal cool packs on the ward. Drink plenty and eat fibre so stools stay soft, because straining hurts; the stool softeners given in hospital help. Our guide to piles after giving birth covers the bottom pain many mums get at the same time, and postnatal recovery after birth covers the rest of the first six weeks.

Episiotomy stitches care in Singapore's heat

Heat and sweat make it harder to keep the area clean and dry, which is the core of KKH's advice. A few habits help:

• Change your pad every two to three hours even if it isn't full, as KKH advises, and more often on hot days.
• Give the stitches some air. The NHS suggests taking off your underwear and lying on a towel on your bed for about 10 minutes, once or twice a day.
• After the toilet, pour or spray clean water over the area and pat it dry from front to back; the NHS says pouring warm water over the area while you pee also eases the sting.
• When you poo, hold a clean pad against the stitches and press gently, which the NHS says takes pressure off the cut. Our guide to piles after giving birth covers your first poo after the birth.
• Wear loose cotton underwear and skip tight shorts until it has healed.

Pelvic floor exercises

KKH teaches Kegel exercises after birth: tighten the muscles you use to stop the flow of urine, hold for three seconds, relax for three seconds, and build up to longer holds, for 15 minutes a session, three times a day. SGH's physiotherapists teach these on the ward. Our pelvic floor guide covers when to get help.

Sex after an episiotomy

KKH recommends waiting until the wound is fully healed, and checking at your postnatal review, usually around six weeks. KKH's doctors in HealthXchange add that side-by-side or woman-on-top positions put less pressure on the scar. Our guide to sex after giving birth has more.

When to see a doctor

In Singapore, the KKH Urogynaecology Centre treats pelvic floor and continence problems after birth, and SGH's Postnatal Assessment Service follows up women who had forceps deliveries or serious tears. Ask your obstetrician for a referral if you are not healing as expected.

Frequently asked questions

Is an episiotomy routine in Singapore?

Singapore hospital pages say first-time mothers may need one, to prevent tears in several directions, but practice varies by doctor. UK guidance says it should not be routine. Ask your obstetrician how often they do one, and note your preference in your birth plan.

How long does an episiotomy take to heal?

KKH's doctors say the pain usually lasts about 2 to 3 days and healing is complete by 6 weeks, when the stitches have dissolved.

Do episiotomy stitches need to be removed?

No. They dissolve by themselves, KKH says.

Is it better to tear or have an episiotomy?

There is no single answer. A small natural tear often heals well, and UK guidance advises against routine cuts. Singapore doctors may cut to stop a tear spreading in several directions or into the back passage, especially with forceps or a vacuum. Discuss it with your doctor before labour.

Can perineal massage prevent an episiotomy?

It may reduce tearing. The RCOG says daily perineal massage from 35 weeks may lower your risk of a tear. It cannot rule out a cut if your baby needs to be born quickly.