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Episiotomy

What is an episiotomy?

An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.

Normally, once the baby’s head is seen, your healthcare provider will ease your baby’s head and chin out of your vagina. Once the baby’s head is out, the shoulders and the rest of the body follow.

Sometimes the vaginal opening does not stretch enough for the baby’s head. In this case, an episiotomy aids your healthcare provider in delivering your baby. It’s important to make a surgical incision rather than letting the tissue tear. Your provider will usually do an episiotomy when the baby’s head has stretched your vaginal opening to several centimeters.

Once you deliver the placenta, your healthcare provider will stitch the cut. If you don’t have an epidural, your provider may inject a numbing medicine into the perineum. This will numb it before the provider repairs the episiotomy.

Why might I need an episiotomy?

Not all women need an episiotomy. Stretching the tissues naturally may help reduce your need for it. Ask your healthcare provider about how to do this on your own. Without an episiotomy, your perineal tissues may tear. This can be harder to repair.

Your provider may advise an episiotomy in these situations:

  • The baby does not have enough oxygen (fetal distress)
  • Complicated birth, such as when the baby is positioned bottom or feet first (breech)  or when the baby’s shoulders are trapped (shoulder dystocia)
  • Long pushing stage of labor
  • Forceps or vacuum delivery
  • Large baby
  • Preterm baby

Your healthcare provider may have other reasons to recommend an episiotomy.

What are the risks of an episiotomy?

Some possible complications of an episiotomy may include:

  • Bleeding
  • Tearing into the rectal tissues and anal sphincter muscle which controls the passing of stool
  • Swelling
  • Infection
  • Collection of blood in the perineal tissues
  • Pain during sex

You may have other risks based on your condition. Be sure to discuss any concerns with your healthcare provider before the delivery.

How do I get ready for an episiotomy?

  • Your healthcare provider will explain the procedure and you can ask questions.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. The form may be part of the general consent for your delivery.
  • Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia.
  • Tell your healthcare provider of all medicines (prescribed and over-the-counter), vitamins, herbs, and supplements that you are taking.
  • Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before labor.
  • Follow any other instructions your provider gives you to get ready.

What happens during an episiotomy?

Your healthcare provider may do an episiotomy as part of your vaginal birth. The procedure and the type of episiotomy may vary based on your condition and your healthcare provider's practices.

Generally, an episiotomy follows this process:

  1. You will lie on a labor bed, with your feet and legs supported for the birth.
  2. If you have not been given any anesthesia, your provider will inject a local anesthetic into the perineal skin and muscle. This will numb the tissues before the incision is made. If epidural anesthesia is used, you will have no feeling from your waist down. In this case, you won’t need more anesthesia for the episiotomy.
  3. During the second stage of labor (pushing stage), as your baby’s head stretches your vaginal opening, your healthcare provider will use surgical scissors or a scalpel to make the episiotomy incision.
  4. Your provider will deliver your baby followed by the placenta.
  5. He or she will check the incision for any further tearing.
  6. Your provider will use stitches (sutures) to repair the perineal tissues and muscle. The stitches will dissolve over time.

What happens after an episiotomy?

After an episiotomy, you may have pain at the incision site. An ice pack may help reduce swelling and pain. Warm or cold shallow baths (sitz baths) may ease soreness and speed healing. Medicated creams or local numbing sprays may also be helpful.

You may take a pain reliever as recommended by your doctor. Be sure to take only recommended medicines.

Keep the incision clean and dry using the method your healthcare provider recommends. This is important after urination and bowel movements. If bowel movements are painful, stool softeners recommended by your healthcare provider may be helpful.

Do not douche, use tampons, or have sex until your healthcare provider says it’s OK. You may also have other limits on your activity, including no strenuous activity or heavy lifting.

You may go back to your normal diet unless your healthcare provider tells you otherwise.

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

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

  • Bleeding from the episiotomy site
  • Foul-smelling vaginal drainage
  • Fever or chills
  • Severe perineal pain

Your healthcare provider may give you other instructions after the procedure, based on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Medical Reviewers:

  • Burd, Irina, MD, PhD
  • Goode, Paula, RN, BSN, MSN