What Is an Episiotomy?

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An episiotomy is an incision that is made to widen the opening of the vagina during labor to enlarge your baby’s exit. In some births, an episiotomy can help to prevent a severe perineal tear or speed up delivery if the baby is in distress and needs to be born quickly.

In the United States, episiotomy was once widely used, but in 2006 the American College of Obstetricians and Gynecologists (ACOG) recommended that episiotomy be carried out only when it is absolutely necessary. This might include situations when the fetus is stressed and needs to be delivered more quickly, or to prevent larger tears that may happen during delivery. 

young woman giving birth with her husband supporting her in the background

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Purpose

During childbirth, the perineum stretches to allow for the baby to come out. Sometimes the vaginal opening does not stretch enough for the baby’s head during delivery and may cause a perineal tear.

Risk of Tearing

You are at greater risk for tearing:

  • During your first vaginal birth
  • If you are having a large baby
  • If you gained substantial weight during pregnancy
  • You are younger

If you are at risk of a serious perineal tear, or if you or the baby are experiencing distress, an episiotomy may aid your healthcare provider in delivering your baby. An episiotomy is usually not needed in a healthy birth without any complications.

An episiotomy is more likely if:

  • The baby needs to be born quickly due to distress or a delivery complication such as cord compression.
  • The baby’s head or shoulders are too big for the vaginal opening.
  • The baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.
  • Instruments (forceps or vacuum extractors) are needed to help get the baby out.
  • You are pushing as the baby’s head is close to coming out, and a tear forms toward the urethral area.

Prevalence of Episiotomy

In 1979, 60.9% of vaginal deliveries involved episiotomies.

Following the recommendation by the ACOG for an episiotomy to be carried out only when absolutely necessary, the rate of episiotomy decreased to 12% in 2012.

What to Expect

During an episiotomy, a small cut or incision is made in the perineum (the flesh between the vagina and the anus) with surgical scissors or a scalpel to widen the opening of the vagina.

A local anesthetic is used to numb the area around the vagina so you do not feel any pain. If you have already had an epidural, the dose may be topped up before the cut is made. This cut is made during the second stage of labor before the baby’s head is delivered.

There are two common types of episiotomy incisions:

  • Midline (median) incision. A median incision is the most common type. It is a straight cut in the middle of the area between the vagina and anus. A midline incision is easier to repair, but it has a higher risk of extending into the anal area.
  • Mediolateral incision. A mediolateral incision is done at an angle. A mediolateral incision offers the best protection from an extended tear affecting the anal area, but it is often more painful and is more difficult to repair.

After the baby is born, the cut is stitched together using dissolvable stitches.

Prevention

There are some things you can do to help reduce your chances of needing an episiotomy, including:

  • Sharing your preference to not have an episiotomy with your doctor, unless it’s medically necessary
  • Proper nutrition (healthy skin stretches more easily)
  • Kegels (exercises for your pelvic floor muscles)
  • Prenatal perineal massage
  • Warm compresses, perineal massage, and support during delivery

Recovery

Your perineum may be swollen and painful after childbirth, especially if you had an episiotomy. The pain and discomfort may last for a week or two as your body begins to heal, but the full healing of your perineal area can take up to six weeks.

To relieve pain or discomfort:

  • Ask your nurse to apply ice packs right after the birth. Using ice packs in the first 24 hours after birth decreases the swelling and helps with pain.
  • Take warm baths but wait until 24 hours after you have given birth. Make sure that the bathtub is cleaned with a disinfectant before every bath.
  • Take medicine like ibuprofen to relieve pain.

You can do many other things to help speed up the healing process, such as:

  • Use sitz baths (sit in water that covers your vulvar area) a few times a day. Wait until 24 hours after you have given birth to take a sitz bath.
  • Change your pads every two to four hours.
  • Keep the area around the stitches clean and dry. Pat the area dry with a clean towel after you bathe.
  • After you urinate or have a bowel movement, spray warm water over the area and pat dry with a clean towel or baby wipe. Do not use toilet paper.

Your stitches do not need to be removed. Your body will absorb them. You can return to normal activities when you feel ready. Wait six weeks before you:

  • Use tampons
  • Have sex
  • Do any other activity that might rupture (break) the stitches

Your healthcare provider will tell you when to return for further treatment or care.

Complications

As with any surgical procedure, there are risks associated with getting an episiotomy.

Not only does an episiotomy mean an extended and sometimes painful healing process in the short term, but also long-term complications can severely disrupt daily life.

Short-term complications can include:

  • Perineal laceration (the incision itself)
  • Hemorrhage and increased blood loss
  • Wound site edema (swelling)
  • Wound site infection
  • Anal sphincter and rectal mucosal damage
  • Urethral injury
  • Bladder injury
  • Perineal hematoma (collection of blood in the perineal tissues)
  • Pain

Long-term effects of episiotomies are not clear, and more studies are needed to determine their effects on urinary and fecal incontinence, sexual dysfunction, and pain during sexual intercourse (dyspareunia).

When to Call a Doctor

Tell your healthcare provider if you experience any of the following:

  • Your pain gets worse.
  • You have a fever or chills.
  • You pass a blood clot larger than a walnut.
  • You have a discharge with a bad odor.
  • The wound seems to break open.

A Word From Verywell

An episiotomy isn’t performed on a routine basis. Your doctor must make this decision at the time of delivery. There are situations where it can be an important intervention, so prepare yourself for this eventuality.

Be sure to follow your doctor’s instructions exactly if you do have an episiotomy. You should also not douche, use tampons, or have sex until your obstetrician clears you. Be sure to keep your postpartum checkups to ensure your perineum is healing correctly.

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  3. American College of Obstetricians and Gynecologists. Practice bulletin No. 165: prevention and management of obstetric lacerations at vaginal delivery. Obstetrics and gynecology. 2016 Jul;128(1):e1. doi:10.1097/AOG.0000000000001523 

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