What you should know about having an episiotomy

Understand indications, risks, benefits, and alternatives

woman and husband talking to doctor

You may have heard it tossed around by other women who have given birth, but do you know what an episiotomy is? It is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening.

Although an episiotomy was once a routine part of childbirth, that’s no longer the case. It was once thought that it would help prevent more extensive vaginal tears, allow for better healing, and prevent the bladder and rectum from dropping. But current research has proven these things not to be true.

But if the situation calls for it, your doctor might need to do an episiotomy for the health of you and the baby. If this happens to be the case for you, you should understand the indications, risks, benefits and if there are any alternatives.

Your doctor may suggest an episiotomy if your baby is large and there simply isn’t enough room for he or she to come out. An episiotomy can also be used if the baby is in distress and needs to be out immediately. It is also used when extensive vaginal tearing appears likely, you are exhausted or if you have a health condition where delivery needs to be as quick as possible to minimize any further health risks.

As with any procedure, there are risks associated with it including:

  • Increased blood loss
  • Increased pain during recovery
  • Longer wait before having sex without discomfort
  • Increased risk for infection
  • Increased risk of tearing in the next birth
  • Increased risk of tearing through anal sphincter or into the rectum, which increases the risk of trouble controlling bowel movements or gas

If you want to try and avoid an episiotomy, there are certain things you can do that might help. One of the best things you can do is gain only the amount of weight recommended for your pregnancy. Excess weight gain can lead to bigger babies, which increase your risk for more severe vaginal tearing or the need for an episiotomy. There are also things you can do during labor to reduce the chance you will need one.

While you are pushing, apply a warm compress to the tissue between your vaginal opening and your anus. You can also do a perineal massage either at home before delivery or during pushing. For this, rub a mild lubricant, such as K-Y jelly, on your thumbs. Place your thumbs just inside your vagina and press downward toward your rectum. Hold for one to two minutes. Start in the last few weeks of pregnancy and repeat the massage at least twice a week for 10 minutes at a time until delivery. Controlling your delivery is also an option. When the baby’s head becomes visible, slow your pushing to allow the baby’s head to stretch the skin and muscles of the perineum.

If you’ve had an episiotomy, your recovery time will be a little different. If you had an epidural, this will provide pain control while stitches are placed. If you did not, then local pain medicine can be used. The stitches will dissolve on their own over the next few weeks. Pain and discomfort can vary in length and can last from 10 days to a month. But, there are many ways to help ease that pain including:

  • Place ice packs on your perineal area immediately after birth.
  • Place a chilled witch hazel pad between a sanitary pad and the wound.
  • Spray warm water over the area while urinating as sometime the urine can cause the area to sting.
  • Sit on a breastfeeding pillow to relieve the pressure and pain.
  • Acetaminophen and ibuprofen can be used, but if that is not strong enough, a prescription pain medication can be ordered. Be aware this can cause constipation and so it is recommended to take a stool softener too.
  • Apply topical pain medication.
  • Expose the stitches to fresh air to encourage healing process. Take off your underwear and lie on a towel for around 10 minutes once or twice a day.
  • Place a clean pad at the site of the cut and press gently when you are passing a stool to relieve pressure on the cut.
  • Take a warm bath.
  • Walk around as much as is comfortable, and practice your pelvic floor exercises. This will stimulate blood circulation in the area and may speed up the healing process.

While you’re healing, expect the discomfort to progressively improve. Contact your health care provider if the pain intensifies, you develop a fever or the wound produces a pus-like discharge. These could be signs of an infection.

One of the big questions women want answered is when they can safely have sex again. Your perineum should be completely healed by four to six weeks after delivery. It is recommended to wait until your postpartum exam before having sex. If you are breastfeeding, the vagina can be dry. So using a water-soluble lubricant will help make sex more comfortable. If you’ve had a tear or an episiotomy, pain during sex is very common in the first few months. Studies have found that 9 out of 10 women who had an episiotomy reported that resuming sex after the procedure was very painful, but that the pain improves over time.

Talk to your provider during your prenatal care about episiotomies. Ask how often and under what conditions they would perform an episiotomy, and how they might help you avoid tearing. (Also ask about others in the practice, in case you end up with someone else at your delivery.)

Being educated and informed can help you to have a safe and healthy delivery for you and your baby.

Posted In Health Information, Pregnancy, Women's