Episiotomy: Everything You Need to Know

An episiotomy is a minor surgery that widens the opening of the vagina during childbirth. It involves cutting the skin and muscles between the vagina and the anus, the area known as the perineum.

This procedure may be needed in fetal distress or if the baby cannot fit through the vaginal opening during childbirth.

This article provides an overview of episiotomies, including the risks, how to prepare, and the recovery process. 

What Is an Episiotomy?

An episiotomy is a surgical technique used during childbirth. The purpose is to widen the opening of the vagina. This procedure was introduced in the 1950s to reduce the risk of severe tears to the perineum. 

Before performing an episiotomy, the healthcare provider injects the perineum with a numbing medication. They then use a scalpel to make a small cut at the opening of the vagina. An episiotomy is only performed when clinically indicated and is not scheduled ahead of time.

Contraindications

An episiotomy is only performed on people giving birth. While this procedure used to be routine, it now is used less frequently because of the risks and possible long-term complications. An episiotomy should only be performed when the person giving birth clearly understands the procedure and its risks. 

Potential Risks 

There are several potential risks of having an episiotomy. Possible risks include:

• Muscle tears
• Bleeding 
• Damage to the rectum 
• Infection
• Scarring 
• Painful sexual intercourse
• Long-term urinary incontinence (leaking urine)
• Restricted movement 

Episiotomies have been associated with an increased risk of severe pain following childbirth. Increased pain may lead to trouble breastfeeding, constipation, anxiety, lower confidence, and lack of desire to have sex.

Purpose of an Episiotomy

The purpose of an episiotomy is to prevent severe tears to the perineum during childbirth. Tears can occur to the vagina and surrounding tissues as the baby’s head and shoulders are born. These tears take time to heal and often require stitches. 

Episiotomies are no longer routinely practiced because of the risks. An episiotomy may be considered in the following cases:

• Fetal distress
• Baby’s head or shoulders cannot fit through the vaginal opening
• Baby is breech (feet come out first)
• Instruments are needed (forceps, vacuum)
• A tear forms in the urethral area

How to Prepare

As you prepare for childbirth, there are steps that you can take to lower your risk of tearing or requiring an episiotomy. To prevent tears, practice the following techniques when pregnant:

• Perform Kegel exercises (repetitive contractions of the muscles in the pelvis)
• Use perineal massage.
• Practice techniques from childbirth class. 

Location

An episiotomy usually occurs in a labor and delivery hospital room during childbirth. It should not be performed at an outpatient center.

Medications

Your healthcare provider will numb the perineum area before performing an episiotomy, even if you have an epidural. A local numbing agent is injected into the perineum muscle and skin.

What to Expect on the Day of Surgery

An episiotomy is not a planned procedure. It may be performed during childbirth if fetal distress or the baby cannot fit through the vaginal opening. 

Before the Surgery

Before the procedure is considered, the person giving birth pushes with contractions. If the baby is distressed or is not able to fit through the vaginal opening, the healthcare team may discuss an episiotomy with the parent. 

During the Procedure

During an episiotomy, the healthcare provider first numbs the area if there is no epidural. The provider then makes a small incision from the opening of the vagina down the perineum. The incision may be median or cut straight down the middle of the perineum. A mediolateral incision is made at an angle and lowers the risk of tearing the anus. A median incision is a more common option.

After the Procedure

After an episiotomy, the baby is delivered. Once the placenta is passed, the healthcare provider closes the incision with stitches. 

Recovery

Recovery from an episiotomy can take several weeks. Fortunately, most people with episiotomies heal without complications. 

Healing

After an episiotomy, your healthcare provider will instruct you on how to care for the incision area. Usually, the stitches do not need to be removed because they are absorbed.

While recovering from an episiotomy, you are also recovering from childbirth. You should not use tampons or have sexual intercourse for six weeks. 

During the weeks after delivery, you can lower your risk of infection by taking good care of your perineum. Some tips to help prevent irritation or further tearing include:

• Change pads every two to four hours.
• Keep the area clean and dry.
• Pat your perineum dry with a soft towel after a shower or bath.
• Spray warm water over the area and pat dry instead of rubbing with toilet paper after the bathroom.

Coping With Recovery

It is common to experience pain after an episiotomy. After childbirth, ice packs help with swelling and pain. Ask your healthcare provider when you can take a warm bath—for most people, waiting until 24 hours after delivery is safe.

It is important to disinfect your bathtub before each bath. In addition to warm baths, over-the-counter Advil (ibuprofen) may relieve pain. 

The pain from an episiotomy can make having a bowel movement difficult. To prevent constipation, drink plenty of water and ask your healthcare provider about taking a stool softener. Eating a diet rich in fiber will also help.

Long-Term Care

To help your perineum muscles heal from an episiotomy, perform Kegel exercises throughout the day. Most people recover from an episiotomy without serious complications. If your pain worsens or you develop new symptoms, such as incontinence, call your healthcare provider immediately.

Summary

An episiotomy is a minor surgical procedure to widen the vaginal opening during childbirth. The purpose is to prevent severe tearing during labor and delivery. Episiotomies were more common in the past but are now used only under specific clinical considerations. 

To reduce the risk of needing an episiotomy, perform Kegel exercises and perineal massage while pregnant. The recovery process for an episiotomy may take several weeks. Most people recover without serious complications. Possible risks of an episiotomy include muscle tears, bleeding, infection, and long-term incontinence.