What is an episiotomy?

We go through what an episiotomy is, why you might need one during childbirth, and how to recover.

What is an episiotomy?

An episiotomy is a cut made in the area called the perineum, which is between the vagina and the anus, during vaginal child birth. An episiotomy is done by a doctor or midwife to enlarge the opening of the vagina in order to help the baby to be born. This may be required for a number of reasons, including if the baby appears to be showing signs of distress or if forceps are required to assist the delivery.  
 
During childbirth, the perineum may tear naturally as the baby’s head emerges. Research has shown selective use of episiotomy may help to reduce more severe perineal tearing or tearing of the vagina.
 
Episiotomies were almost a routine part of childbirth in the late 1970s as it was thought to speed delivery and that the straight cut would heal better than a natural tear. However this is no longer the case and routine episiotomies are no longer recommended. 

Why might you need an episiotomy?

Although episiotomies are no longer routinely recommended, the procedure may still be required in certain cases. 

Episiotomy may be required if there is a need to deliver the baby quickly for their safety, for example if the baby’s heart rate slows significantly before birth, or if oxygen supply to the baby is compromised.  

You may also need an episiotomy if there is a risk of significant vaginal tearing, for example your baby may be large, in an difficult position or requires the use of forceps for delivery. The advantage of an episiotomy over a natural tear in this instance is to prevent severe tears that may affect the anal muscle. 

Your doctor or midwife may recommend an episiotomy during your delivery. The decision to make an episiotomy is based on what happens during the birth of your baby and cannot be made beforehand. 
a woman with her newborn baby born via episiotomy

What happens during an episiotomy?

The type of episiotomy and the procedure itself may vary based on your condition, but generally an episiotomy follows the process below: 

  1. You will be given an injection of local anaesthetic into the skin and muscle of the perineum. This causes the area to go numb so you won’t feel the incision being made. If you have had an epidural you won’t be able to feel anything from the waste down and may not need more anaesthesia for the episiotomy, though your doctor may top up this dose before the procedure. 
  2. During the pushing stage of labour, as your baby’s head causes your vaginal opening to stretch, your doctor will use a scalpel or surgical scissors to make the episiotomy incision. There are two types of episiotomy incisions: midline or mediolateral. A midline incision is done vertically between the vagina and the anus; and a mediolateral incision is done at an angle. 
  3. Once the episiotomy has been performed, your baby will be delivered through the enlarged vaginal opening. 
  4. The placenta (afterbirth) will then be delivered. 
  5. Your doctor will then examine the incision made to check for any further tearing that may have occurred during the birth.
  6. Dissolvable stitches (sutures) are then used to repair the incision to the perineal tissue and muscle. 

Pros and cons of an episiotomy 

As with any procedure, there are risks associated with having an episiotomy. Your doctor or midwife will weigh up the risks as compared to the benefits for both you and your baby and discuss this with you in more detail.
 
Complications that can occur as a result of an episiotomy include;
  • a further tear to the incision which may extend to the rectum and impact the anal sphincter muscle that controls the passing of stools,
  • blood loss due to the incision and blood may collect in the perineal tissues,
  • a risk of infection in the cut,
  • some women may find sex painful for a few months after giving birth. 
Despite the risks, episiotomy may be required in some cases for a safe delivery of your baby. You should discuss episiotomies with your doctor or midwife ahead of delivery to ensure that you are both comfortable and informed. 

Recovering from an episiotomy

Episiotomy recovery can be uncomfortable or even painful. The degree of pain will depend on how long and deep the incision is. Pain may be particularly noticeable when you walk or sit, but can also impact urinating and bowel movements for at least a week. For some women, the first bowel movement following an episiotomy can be quite painful. 

Pain from an episiotomy can last for a few weeks, though tenderness from an extensive incision or tear can last longer. 

The stitches used to repair the episiotomy will dissolve on their own. While recovering, there are a number of ways to promote healing and help ease pain: 

  • Your doctor may suggest over-the-counter or prescription medication to aid in your recovery. These may include pain-killers, anti-inflammatoires, stool softeners, and anaesthetic sprays.
  • You can soothe the wound by placing a cold ice pack wrapped in a towel on the area (never put an ice pack directly on your skin, and only apply for 20 minutes each hour). You can also chill a witch hazel pad and place this in your underwear between a sanitary pad and the wound. 
  • To prevent stretching or pain during bowel movements, press a clean sanitary pad against the perineum to provide support to your wound as you are passing a bowel movement. Drinking lots of fluids will also help soften stools.
  • To avoid infection, only wipe your perineal area from the front to back, starting at your vagina and working back towards the anus
  • To help with stinging during urination, pour warm water on your vulva as you urinate. Rinse yourself using a squeeze bottle afterwards. 
  • It may be painful to sit in the weeks following an episiotomy. To help with this, sit on a pillow or a padded ring (you can buy these from your local pharmacy). You can also tighten your buttocks as you lower yourself into a seat. 
  • Lavender may help with pain after an episiotomy. If your doctor says this is ok you can add a few drops of lavender oil to your bath.
  • Taking regular warm baths using Epsom salts and other additions suggested by your doctor may help relieve pain and reduce swelling to the perineal area.
An episiotomy might be unexpected and require you to take some extra care after giving birth, but it might help to ensure you have a safe delivery and a healthy baby.
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