What Is an Episiotomy?

An episiotomy is a surgical cut on the perineum (the space between the vaginal opening and rectum) just before the baby's head comes out. There are two types: midline and mediolateral. A midline is cut directly downward and is the most common in the United States. A mediolateral is cut at an angle. Episiotomies used to be a routine procedure in all vaginal births. Now, most doctors only perform them 20%-30% of the time.

Episiotomies are repaired with sutures by your care provider as soon as your placenta is delivered. If you're not numb from an epidural, your care provider will give you local anesthesia shots so you don't feel the repair work. Since you are usually holding your baby at this point, your attention is likely to be focused on your child.

Why Are they Given?

Care providers perform episiotomies because the procedure enlarges your vaginal opening. It can shorten delivery time, which is very important if your baby is compromised.

A surgical incision may also be done for the delivery of a breech baby or a baby with an arm, shoulder, or face presenting.

An episiotomy will probably be done for a forceps delivery. It may or may not be done for a vacuum delivery. Usually an instrumental delivery (forceps or vacuum) is the final step before a cesarean.

Experts used to believe that a surgical cut into the perineum would prevent the natural and normal vaginal tearing that occurs during delivery. Doctors believed that an episiotomy would be easier to repair and be less severe than a vaginal tear. Now the majority of experts agree the minor vaginal tearing during delivery is usually less severe than a surgical cut. Some doctors even feel that reparing of a vaginal tear is easier and less time intensive than the repair work of an episiotomy.

What Are the Complications Involved?

The main complication is extension of the incision into the muscles of rectum or into the rectum itself. Other complications include vaginal pain, infection, bleeding, and pain during sex.

How can I Avoid One?

There are many things you can do to try to avoid an episiotomy.

  • Chose a care provider with a low rate, who prefers to avoid the procedure.
  • Eat nutritious meals during pregnancy to promote healthy tissues.
  • Talk to your care provider about perineal massage a few weeks before you give birth.
  • Ask your care provider whether he/she uses mineral oil, perineal massage, or warm compresses during the birth process.
  • Use upright positions to make birth more efficient, if you don't have an epidural.

Remember that no matter what you do, no care provider can guarantee that you will not need one for the safety of your baby.

How do I Heal After Getting One?

As soon as your care provider is finished with the repair work, your nurse will give you an ice pack for your perineum. Continue to use an ice pack for as long as there is swelling at the site.

When you go home you may try a sitz bath. A sitz bath is a shallow warm or cold bath that just covers your perineum. Some people add herbs to the water to promote healing. If you decide to use herbs, check with your provider first.

Your care provider will probably recommend an over-the-counter medicine for pain relief. Aspirin is not recommended because of the risk of bleeding, but ibuprofen is a good choice.

You should keep the site dry and clean. Your nurse will probably give you a peri-bottle--a small squirt bottle you can use on your perineum after urinating and bowel movements.

Your first bowel movement may be uncomfortable. You should make sure you eat lots of fiber those first few weeks. If your episiotomy has extended into your rectum, your care provider will probably prescribe a stool softener.

Call you care provider if you notice bleeding from the episiotomy site, foul-smelling discharge, fever/chills, or an extremely painful perineum.

Healing may take some time. You should use care not to douche, use tampons, or have sex too quickly. Sex may be painful in the beginning and you, and your partner may have to be patient.