What Is an Episiotomy?

Episiotomies are sometimes necessary to help with labor.

An episiotomy is a surgical procedure to widen the opening of the vagina during childbirth.

During labor, your perineum — the skin and muscles between your vagina and anus — will be numbed with a shot, if you haven't already been given an epidural.

Then, a small, straight incision will be made in the middle of the perineum.

Alternatively, the incision may be made at an angle — a cut that is less likely than a straight incision to tear through the anus, but may take longer to heal.

After delivering your child and placenta, your doctor will stitch the incision closed.

Reasons for an Episiotomy

Though recent studies show births without an episiotomy are best for most women in labor, there are certain situations in which the procedure may be necessary.

For example, your doctor or midwife may decide you require an episiotomy if:

• Your baby's head or shoulders are too large to fit through your vaginal opening
• You or your baby is in distress and delivery needs to be sped up
• Your baby is in breech position (its feet or rear is coming out first) and there is a complication
• You're unable to stop or slow your pushing
• Instruments, such as forceps or a vacuum extractor, need to be inserted into your vagina to get your baby out

Episiotomy Risks

Episiotomy may result in a few different complications, including:

• Infection
• Large tears from the incision that may extend through the anus
• Bleeding and perineal hematoma, a collection of blood in the perineal tissues
• Painful intercourse
• Perineal pain

If you're worried about these risks, there are a few steps you can take to lower your chances of needing an episiotomy, such as:

• Practicing Kegel exercises
• Massaging your perineum during the six weeks before your expected delivery
• Childbirth class lessons to better control your breathing and urge to push during labor

Episiotomy Care and Healing

After your procedure, wait six weeks before you engage in any activity that might rupture your stitches, including using tampons, having sex, and douching.

To reduce the pain of the incision, you can:

• Use pain relievers, such ibuprofen, medicated creams, and local anesthetic sprays
• Take a warm, clean bath (wait at least 24 hours after giving birth)
• Apply ice packs immediately after birth

To avoid painful bowel movements, take stool softeners, drink lots of water, and eat a lot of fiber.

Frequent sitz baths, or shallow baths that cover your vulvar area, may help speed healing. Be sure to dry off carefully when you are done.

Also make sure to keep the area clean and dry, and avoid using toilet paper (use a spray bottle of warm water and pat dry with clean gauze).