“Less Pain, Better Healing”: Addressing Postpartum Perineal Pain in Rural India through Evidence-Based Episiotomy Suturing

Dr. Sadhna Sharma

“Less Pain, Better Healing”: Addressing Postpartum Perineal Pain in Rural India through Evidence-Based Episiotomy Suturing

Author(s)	Dr. Sadhna Sharma
Country	India
Abstract	Background & context. Postpartum perineal pain is one of the most common morbidities after vaginal birth. In India—where ~89% of births are now institutional (and ~87% even in rural areas)—perineal trauma from episiotomy or spontaneous tears affects large numbers of new mothers, with consequences for mobility, breastfeeding, continence, sexual health, and mental wellbeing. Global guidance discourages routine episiotomy and emphasizes correct repair, yet studies from Indian settings continue to report high and variable episiotomy rates and gaps in repair technique, supplies, and training, especially in rural facilities. (dhsprogram.com, PMC, BioMed Central) Objective. To synthesize current global and India-specific evidence on postpartum perineal pain and evaluate how proper episiotomy suturing—technique, materials, and implementation—can reduce pain and complications in rural healthcare settings. Methods. A narrative review of peer-reviewed studies, guidelines (WHO, NICE, RCOG, FOGSI), Indian government policies (MoHFW, NHM/LaQshya, IPHS), program evaluations (Dakshata, Manyata), and credible educational media (Global Health Media, RCOG/OASI). Database and web searches emphasized 2020–2025 evidence with Indian context prioritized; older seminal trials were included for technique/materials. (WHO Apps, NICE, rcog.org.uk, National Health Mission, BioMed Central, Global Health Media Project) Key findings. (1) Technique matters: continuous (non-locking) layered repair reduces short-term pain and need for re-intervention versus interrupted sutures; figure-of-eight stitches should be avoided. (ScienceDirect, cochranelibrary.com, rcog.org.uk) (2) Material matters: rapidly absorbable synthetic sutures (polyglactin 910/polyglycolic acid) are associated with less pain and fewer removals than chromic catgut. (PubMed, ijrcog.org, PMC) (3) Angle matters: when episiotomy is indicated, a mediolateral incision at ~60° at crowning reduces OASI risk; angle-guiding tools improve consistency. (NICE, NCBI) (4) Systems matter: Rural shortages of specialists, variable adherence to protocols, and limited simulation training are key pain drivers; initiatives like LaQshya, Dakshata, NPM/MLCUs, and Manyata offer scalable pathways for improvement. (Rural India Online, National Health Mission, PMC) Conclusions & recommendations. Reducing postpartum perineal pain in rural India requires: standardized technique/materials, angle-aware episiotomy, routine analgesia protocols, and targeted capacity-building (midwifery-led, simulation-based) within national quality platforms (LaQshya/Manyata).
Keywords	perineal pain; episiotomy suturing; rural India; mediolateral angle; continuous repair; polyglactin 910.
Field	Medical / Pharmacy
Published In	Volume 17, Issue 4, October-December 2026
Published On	2026-10-12

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“Less Pain, Better Healing”: Addressing Postpartum Perineal Pain in Rural India through Evidence-Based Episiotomy Suturing

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