What You Need to Know About an Episiotomy

An episiotomy is a surgical incision you may have during childbirth to help you deliver your baby. It is done to help enlarge the vaginal opening. This procedure was routinely done 20 years ago with the belief that it offered you a greater chance at healing over a spontaneous tear. However, now experts feel that an episiotomy should only be done when absolutely necessary because for many patients, the benefits are not outweighing the risks. When you are preparing to give birth and getting your birth plan together, it is important that you make your thoughts and wishes concerning an episiotomy clear. For some women, this procedure is beneficial, but for some it is not and you, along with your health care team, will have to make this decision if it arises. Here we will lay out the details concerning this procedure to help make that decision a little less difficult should it arise during your labor and delivery.

Episiotomy or Tearing Naturally?

Research shows that if you experience a spontaneous tear you will typically recover at the same rate that you would if you had an episiotomy. In many cases, you will experience fewer complications and recover in less time from a spontaneous tear. Women who have an episiotomy often experience more pain during recovery, tend to lose more blood during delivery and have to abstain from sex longer. This procedure also increases the risk of infection.

This procedure increases your risk of experiencing a more serious tear through your anal sphincter. This tear may even go all the way to your rectum. If this occurs, you will require a significantly longer recovery time, more perineal pain after giving birth and the strength of your pelvic floor muscles is likely to be affected. If your anal sphincter is disrupted by a tear, anal incontinence is possible which can result in difficulty controlling gas and bowel movements.

Why Might I Need an Episiotomy?

Several reasons may contribute to you needing this procedure: If your perineum has not had adequate time to slowly stretch and birth is imminent; if you need a vacuum or forcep-assisted delivery; if your baby is in distress; if your vaginal opening is not large enough for your baby's head; or if you cannot control your pushing, this procedure may be necessary.

How is an Episiotomy Performed?

If it is decided that this procedure is necessary for you, you will be given an injection of local anesthetic. A small incision will be made in your perineum using surgical scissors. Before stitching up the incision, you may be administered another injection of local anesthetic to ensure you are completely numb.

Can I Prevent an Episiotomy?

There are measures you can take to help lessen the chance you will need one, but nothing can be done to definitely eliminate the chance. Some preventative measures include good nutrition, support and warm compresses during delivery, not lying on your back as you push, kegel exercises, perineum massage techniques and slowed second stage labor with controlled pushing.

Are there Any Side Effects of an Episiotomy?

There are risks associated with this procedure. Talk to your doctor to assess your individual risk of experiencing them. They may include infection, swelling, extended healing time, future problems with incontinence, bruising, bleeding and a painful scar which may prolong abstinence.

Recovering from an Episiotomy

With an episiotomy or a spontaneous tear, there will be recovery time. You will have some stitches and the area will typically be quite tender. The stitches will be dissolvable so you will not have to have them removed. It usually takes a few weeks for the stitches to completely dissolve.

Some women report their pain being mostly gone within just a week or two while other women report still experiencing discomfort a month or more after having this procedure done.

Immediately after giving birth, you should apply ice packs to your perineal area to help in reducing swelling and pain. This should be done intermittently for the first 12 hours.

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Resources

MedlinePlus: Episiotomy

American Pregnancy Association: Episiotomy