Can a hospital force me to have an episiotomy?

No. Except in a life-threatening emergency, you must give informed consent before any procedure.

What if I tear badly without an episiotomy?

Severe tears are uncommon, and many heal better than surgical cuts. If repair is needed, stitches are given under anaesthesia.

Should I put “no episiotomy” in my birth plan?

Yes. Writing it down and discussing it with your doctor ensures your preference is respected.

Are there ways to reduce the need for episiotomy or tearing?

Yes. Perineal massage, upright labour positions, warm compresses, and avoiding forceful pushing can help protect the perineum.

Can I Refuse an Episiotomy in India?

Childbirth is unpredictable, but it should never mean giving up your right to decide what happens to your body. One of the most debated practices in Indian delivery rooms is the episiotomy, a surgical cut at the vaginal opening, often done “just in case.” Many mothers learn about it only after it has already been performed, leaving them with physical pain and emotional resentment. But here is the truth: unless it is a medical emergency, you can refuse an episiotomy in India.

What Exactly Is an Episiotomy?

An episiotomy is a surgical incision made in the perineum, the tissue between the vagina and anus, during the pushing stage of labour. Doctors usually make this cut to enlarge the vaginal opening for the baby’s head to pass.

For years, episiotomies were considered routine, especially for first-time mothers. However, research shows that they do not prevent severe tears as once believed. In fact, natural tears are often smaller, less painful, and heal more quickly than surgical cuts.

Why Episiotomy Is No Longer Routine

Today, both the World Health Organisation (WHO) and FOGSI (Federation of Obstetric and Gynaecological Societies of India) advise that episiotomy should only be done selectively, not for every birth.

Here’s why:

Increased recovery pain – Surgical cuts are deeper and often more painful than natural tears.
Higher infection risk – Stitches near the vaginal and anal region can be prone to infection.
Sexual discomfort – Scar tissue may cause pain or tightness during intercourse months later.
Not always effective – Routine episiotomies have not been proven to prevent pelvic floor issues or incontinence.

When It Might Still Be Needed

There are certain situations where an episiotomy can be medically justified. For example:

Foetal distress: If the baby’s heart rate shows signs of oxygen shortage and delivery needs to be sped up.
Instrumental delivery: When forceps or a vacuum are used, an episiotomy may make the procedure safer.
Very large baby or shoulder dystocia: To prevent uncontrolled tearing in rare emergencies.

In these cases, doctors may recommend an episiotomy as a safer option. But even then, informed consent is required.

Your Rights in India

Under Indian medical ethics and law, no procedure can be performed without your consent, except in life-threatening emergencies. This applies to episiotomy as well.

Informed consent: Doctors must explain why the cut is necessary, its risks, and possible alternatives.
Right to refusal: You can clearly state you do not consent to routine episiotomy.
Birth plans: Including “no routine episiotomy” in your written birth plan helps avoid confusion during labour.
Advocacy: Your partner or support person can speak up on your behalf if you’re in pain or unable to respond.

In reality, some Indian hospitals still treat episiotomy as standard practice, especially in smaller towns or teaching institutions. This is why proactive communication is key.

How to Say No Without Conflict

In the intensity of labour, it can be hard to argue. Preparing early makes a big difference.

Talk to your doctor in advance: At your antenatal visits, ask about their policy on episiotomy. Choose a hospital or doctor that follows evidence-based practice.
Include it in your hospital paperwork: Some hospitals allow a birth preference sheet. Add a line refusing routine episiotomy.
Use clear language: Say “I do not consent to episiotomy unless it is a clear medical emergency.”
Empower your partner: If you are unable to speak during contractions, your partner should be prepared to remind staff of your preference.

What to Expect if You Refuse

Refusing does not mean putting your baby at risk. In most vaginal births, natural tears, if they happen, are small and heal with minimal stitches. Many women give birth without tearing at all.
If you refuse, doctors will usually allow labour to continue without cutting, unless there are emergency signs. In that case, they should explain quickly and request permission before proceeding.

Healing: Natural Tears vs Episiotomy

Natural tears: Usually shallow, irregular, and heal faster with less pain.
Episiotomy: A straight surgical cut, often longer, requiring more stitches and a longer recovery.

Good perineal care, like warm compresses during labour, perineal massage in late pregnancy, and controlled pushing, can further reduce the chances of severe tearing.
In India, you can absolutely refuse an episiotomy unless it is a genuine emergency. The law is on your side, and global as well as Indian guidelines discourage routine use. The key is to prepare in advance, communicate clearly, and ensure your birth partner supports your decision. Childbirth is about bringing your baby into the world safely, but it should also respect your right to dignity, choice, and control.

Emotional Impact of Unwanted Episiotomy

For many women, the issue is not just physical pain but the loss of control. An unconsented episiotomy can feel like a violation, leaving emotional scars. Recognising this helps you prepare not only for the physical aspects of birth but also for protecting your autonomy.
Counselling, postpartum physiotherapy, and open conversations with your care provider can help in recovery, both body and mind.
Whether you’re pregnant, a new mom, or navigating postpartum, you don’t have to do it alone. Join our support group to connect, share, and support one another.

FAQs on Can I Refuse an Episiotomy in India?

Can a hospital force me to have an episiotomy?
No. Except in a life-threatening emergency, you must give informed consent before any procedure.
What if I tear badly without an episiotomy?
Severe tears are uncommon, and many heal better than surgical cuts. If repair is needed, stitches are given under anaesthesia.
Should I put “no episiotomy” in my birth plan?
Yes. Writing it down and discussing it with your doctor ensures your preference is respected.
Are there ways to reduce the need for episiotomy or tearing?
Yes. Perineal massage, upright labour positions, warm compresses, and avoiding forceful pushing can help protect the perineum.