Episiotomy: Definition, Care, and Healing

An episiotomy is a surgical cut made at the perineum during childbirth to widen the vaginal opening quickly. Episiotomies are usually only performed under special circumstances, and they usually heal within a few weeks. Read on to find out more about what an episiotomy is, why your healthcare provider may perform it, and how to care for the incision while it heals.

What Is an Episiotomy?

An episiotomy is a surgical cut made by your healthcare provider during labor. It widens the vaginal opening to help make delivering your baby a little easier.

Episiotomies used to be a routine procedure during vaginal childbirth but now their use is more limited. This is because, in the past, episiotomies were thought to help prevent extensive vaginal or perineal tears (or perineal lacerations) and were thought to heal better than natural tears. In addition, they were considered to help maintain the muscular support of the pelvic floor. Current research indicates that episiotomies don’t prevent these problems or provide these benefits, so their use is not as common now.

If you wish to try to avoid an episiotomy, let your healthcare provider know. She can tell you about the circumstances in which she might need to perform one. If you have a preference either way about this procedure, you might also like to add it to your birth plan if you’re writing one. Just make sure you discuss your preferences and what’s in your birth plan with your healthcare provider well before your due date.

Why Might I Need an Episiotomy?

It takes time for the vagina to stretch during childbirth. Some conditions may arise that require your baby to be delivered before your vagina has had enough time to stretch, and an episiotomy may be performed to help prevent tearing. Your healthcare provider will know when an episiotomy is the safest option for you and your baby.

Here are some circumstances in which your baby might need to be delivered quickly:

• Shoulder dystocia. This is when your baby's shoulder is stuck behind your pelvic bone.

• Your baby has an abnormal heart rate during delivery.

• Your baby requires an operative vaginal delivery. This is when either forceps or vacuum extraction (using a special suction cup) are used. An operative vaginal delivery may be done if you've been pushing for a long time without progressing as expected, or if you're not able to push the baby out because of a medical condition or an issue with the baby.

How Is an Episiotomy Performed?

If you haven't had an epidural, you'll likely get an injection with a local anesthetic to numb the area of incision. The area that is cut is the perineum, the spot between the vagina and anus.

Episiotomies are usually done at the end of the second stage of labor and delivery, when pushing has already started and the baby's head has appeared at the opening of the vagina. You won't feel the incision or the repair because the area will have been numbed. The incision is repaired with stitches.

What Types of Episiotomy Incisions Are There

There are two types of episiotomy incisions:

• The midline (median) episiotomy incision. This is done vertically from the vaginal opening straight down toward the anus. A midline incision has a higher risk of extending to the anus, but is easier to repair.

• The mediolateral episiotomy incision. This is done at an angle from the vagina down toward the left or right of the anus. This incision can help prevent an extended tear toward the anus, but it's often more painful and difficult to repair.

What Is the Recovery Like After an Episiotomy?

Typical episiotomy wounds will heal within a few weeks, but more extensive wounds can take longer. Your healthcare provider might prescribe medication or suggest an over-the-counter pain reliever or stool softener to help ease the discomfort of recovery.

Topical pain-relieving creams or ointments aren't found to be effective in helping with episiotomy wounds, but there are a few things you can do to ease the discomfort or itching as your episiotomy heals:

• Use a pillow or padded ring when you need to sit (check our hospital bag checklist for ideas about pillows and other items that will help you stay more comfortable after childbirth)

• Run warm water on your perineum, perhaps with a squeeze bottle, when you urinate

• Cool the area with an ice pack or put a chilled witch hazel pad on the area

• Making sure the affected area is covered by water, sit in a shallow bath of warm or cool water - whichever is more soothing to you – for about five minutes

• If needed, ask your healthcare provider about a numbing spray or cream.

When to Call Your Healthcare Provider During Recovery

In the days and weeks after you've delivered, it's likely that your discomfort will continuously improve. If the pain doesn’t improve or gets worse, or if you develop a fever or the wound starts producing pus, contact your healthcare provider. Unless your provider tells you otherwise, you probably won’t need to go in to get the stitches removed as these usually absorb on their own.

What Are the Risks and Side Effects of an Episiotomy?

Although these side effects of an episiotomy are possible, trust your healthcare provider to weigh the benefits and risks when deciding if an episiotomy is right for your situation:

• Sometimes the incision of an episiotomy is more extensive than a natural tear might have been

• As with perineal tears, infection is also possible with an episiotomy

• An episiotomy can cause pain during sex for some women in the months after childbirth

• A midline episiotomy puts you at risk of 4th degree tearing, which is a tear that extends through the anus and into the mucous membrane lining the rectum. Fourth degree tears usually require a surgical operation to repair.

• Fecal incontinence is possible. If this occurs, your healthcare provider can suggest options for treatment.

You might have a preference for or against an episiotomy, or not have a strong feeling either way. It's good to know in advance what this procedure entails and to have an open mind should something unexpected occur during labor and delivery.

Your healthcare provider is an expert and is doing what's best for both you and your baby. Whether or not you end up needing an episiotomy, she will guide you in healing after childbirth.