Episiotomy

An episiotomy is a procedure sometimes performed during childbirth to help make delivery smoother. While it’s not needed in every birth, there are certain cases where your healthcare provider might recommend it. Many parents are curious about what an episiotomy involves and how the healing process works. In this article, we’ll explore the meaning of episiotomy, why it might be used, and what you can expect during recovery.

What Is an Episiotomy?

An episiotomy is a surgical incision of the perineum made by your healthcare provider during labor to help widen the vaginal opening and make delivery easier. While episiotomies were once a routine part of vaginal childbirth, they are now performed less frequently. In the past, it was believed that episiotomies could help prevent severe vaginal or perineal tears and promote better healing compared to natural tearing versus episiotomy. They were also thought to support the pelvic floor muscles better. However, current research shows that an episiotomy does not prevent these issues or offer additional benefits, so their use has become less recommended. If you’re hoping to avoid an episiotomy, discuss this with your healthcare provider ahead of time. They can explain when and why an episiotomy might be necessary.

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.

Types of Episiotomy Incisions

There are two main types of episiotomy incisions that may be performed during childbirth:

• Midline (Median) episiotomy incision. This incision is made vertically, starting from the vaginal opening and extending straight down toward the anus. While this type of episiotomy is usually easier to repair, it does carry a higher risk of extending into the anus.

• Mediolateral episiotomy incision. This incision is made at an angle from the vaginal opening, down toward the left or right side of the anus. It’s often chosen to help prevent a tear from extending into the anus, but it tends to be more painful and can be more challenging to repair.

Natural Tear vs Episiotomy

During childbirth, a natural tear may occur as the baby passes through the vaginal opening. In contrast, an episiotomy is a deliberate incision made by your healthcare provider. Both options have their pros and cons, and the choice depends on the circumstances of your delivery.

A natural tear can happen gradually as the tissues stretch, and while it may not always tear in a controlled way, it often heals well on its own. Some studies suggest that natural tears may be less painful and heal faster than an episiotomy. However, severe tears may extend into the anus, potentially leading to complications.

An episiotomy, on the other hand, allows the healthcare provider to make a precise incision, potentially reducing the risk of an uncontrolled or severe tear. But, because an episiotomy is a surgical cut, it may involve a longer healing time and more discomfort compared to a natural tear.

Discuss your preferences with your healthcare provider, so they can guide you based on your specific delivery needs. Whether you experience a natural tear vs. episiotomy, your provider will help manage the situation for the safest outcome for you and your baby.

Healing Process of Episiotomy

Most episiotomy wounds heal within a few weeks, though more extensive incisions may take longer to fully recover. Understanding the different episiotomy healing stages can help manage expectations and ensure proper episiotomy care during recovery. Your healthcare provider might recommend over-the-counter pain relievers, prescription medication, or a stool softener to ease any discomfort.

While topical creams and ointments aren’t typically effective, there are several ways to care for an episiotomy and manage discomfort during the episiotomy healing time:

• Use a pillow or padded ring when sitting to reduce pressure on the area (check our hospital bag checklist for more helpful items).

• Run warm water over your perineum with a squeeze bottle (known as a “peri bottle,” which is usually provided to you by your healthcare provider) when urinating to ease stinging.

• Cool the area with an ice pack or apply a chilled witch hazel pad to reduce swelling.

• Sit in a shallow bath of warm or cool water, ensuring the affected area is submerged, for about five minutes to soothe discomfort.

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

Proper care for an episiotomy can make the healing process smoother. If you notice signs of infection or the wound isn’t healing as expected, consult your healthcare provider for further guidance.

Complications of Episiotomy

While an episiotomy can be helpful in certain situations, it carries some complications, including:

• Severe tearing. The incision may extend beyond what was intended, leading to third- or fourth-degree tears that affect the anal sphincter or rectum.

• Infection. As with any surgical procedure, there is a risk of infection, which can cause additional pain and delay healing.

• Painful intercourse. Some parents may experience discomfort during sex for months after the procedure.

• Pelvic floor issues. A severe tear can lead to problems like urinary incontinence or pelvic floor dysfunction.

• Extended recovery. Healing times may be longer, and scarring can occur, especially with more extensive incisions.

These episiotomy complications can also occur with natural tears. Your healthcare provider will assess your specific case to determine the best course of action.

How Long Does an Episiotomy Take to Heal?

Healing from an episiotomy usually takes about one month, but this may vary depending on the degree of the incision. Recovery times for natural tears are usually similar to those for an episiotomy.

It’s common to feel pain and soreness during the first few weeks, and some discomfort with sex, after your healthcare provider gives the “OK”, to resume intercourse. Be sure to communicate with your provider about how you’re recovering and what your pain levels are. They can help determine whether your recovery is progressing normally based on the type and severity of the episiotomy you had.

Episiotomy Infection Signs and Symptoms

It's important to keep an eye on your episiotomy as it heals and contact your healthcare provider right away if you experience any of the following symptoms, as they could indicate an infection or complications such as a separation of the repaired area:

• Severe pain or pain that gets worse over time.

• Pain that won’t go away. Despite following recommended care.

• Fever, which could signal an infection.

• Leaking urine or leaking stool, which may suggest issues with healing or a more severe tear.

These symptoms should be addressed immediately to prevent further complications and ensure proper recovery.

The Bottom Line

Birth plans can be unpredictable, and you might not have a strong feeling about whether or not an episiotomy is needed. What matters most is understanding the procedure and trusting that your healthcare provider will do what’s best for you and your little one in the moment.

Whether or not an episiotomy is necessary, your provider will guide you through the healing process and help ensure a safe recovery after childbirth.

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_{How We Wrote This Article The information in this article is based on expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}