Episiotomy

Overview

An episiotomy is a small cut that a doctor makes in the area between the vagina and anus, called the perineum, during childbirth to help widen the opening for the baby. Sometimes, doctors do this procedure to make delivery easier or to prevent more serious tearing.

Episiotomies were once very common, but doctors now use them less often because research shows they are not always necessary. While some people might need one during labor, most can give birth without it.

Many people have questions about why and when an episiotomy is needed, as well as the risks and recovery process. Understanding the facts about this procedure helps parents make informed choices and feel more prepared for childbirth.

What Is an Episiotomy?

During childbirth, a doctor may make a small cut in the perineum to help the baby pass through the vaginal opening more easily. Doctors only do this when they believe it is necessary, and practices have changed over time.

Definition and Purpose

During vaginal delivery, a doctor may make an incision in the perineum, the area between the vaginal opening and the anus. The main purpose is to widen the vaginal opening when the baby is being born. This cut can help ease the baby’s passage and lower the chance of uncontrolled tearing of the vaginal and perineal tissues.

Doctors may do an episiotomy if the baby’s head is too large, if the baby is in distress, or if they need to speed up the delivery for safety reasons. Doctors do not consider episiotomy a routine part of childbirth today. In most cases, vaginal tissue stretches on its own, but in certain situations, this procedure can make delivery safer for both mother and baby.

Historical Use and Changing Trends

Episiotomies used to be a routine part of childbirth in many hospitals. Doctors believed that making a controlled cut would help prevent severe tearing, protect the pelvic muscles, and speed up delivery. In the 1970s and 1980s, most women having a vaginal birth received one. Research has shown that routine episiotomies are not always needed and can sometimes cause more harm than good.

Complications like pain, bleeding, infection, and longer healing times can happen after this surgery. Most health experts now recommend using an episiotomy only when there are clear medical reasons. Today, the rate of episiotomies has dropped, and doctors look for other ways to support a safe vaginal delivery.

Reasons for Episiotomy During Delivery

Doctors may do an episiotomy if the baby’s heart rate drops quickly or if there are signs of distress during the final stage of labor. This can help speed the birth and possibly prevent further complications for the baby. Sometimes, doctors use an episiotomy if the baby’s shoulders get stuck after the head is delivered (shoulder dystocia). If the vaginal opening is very tight or there is a risk of a severe natural tear toward the anus, a doctor might also choose to do this procedure.

When tools like forceps or a vacuum are needed to help with delivery, an episiotomy can make it easier and lower the risk of unpredictable tearing. The decision is made with the safety of both the mother and the newborn in mind.

Types of Incisions

There are two common types of episiotomy incisions:

Type	Description
Midline	The cut goes straight down from the vaginal opening toward the anus. This type is easier to repair, but it has a higher risk of extending into the anal muscles.
Mediolateral	The cut angles to the side from the vaginal opening. It is less likely to reach the anal muscles but can be harder to repair and may cause more discomfort during recovery.

Doctors rarely use other variations, and only for special cases. The choice of incision depends on the mother’s anatomy, the baby’s size, and the specific situation during childbirth. Doctors perform both types under local anesthesia and stitch the area closed afterward.

Episiotomy Procedure Overview

During vaginal delivery, a doctor may make a small cut in the perineum if needed.

Steps of the Procedure

1. The health care provider decides if an episiotomy is needed during labor.
2. The provider cleans and numbs the perineum with a local anesthetic to reduce pain.
3. The provider makes a quick incision to widen the vaginal opening.

This incision can help make more space for the baby if there are difficulties during delivery. Doctors most often use an episiotomy when the baby is in distress or when a quick delivery is necessary. After delivery, the provider stitches the incision closed. These stitches usually dissolve on their own as the area heals. Types of incisions usually fall into two categories:

Type	Description
Midline	Straight down from the vaginal opening.
Mediolateral	Angled to the side of the perineum.

The provider chooses the incision type based on the situation and their judgment. Most women can expect some pain and swelling in the area after an episiotomy. Ice packs, pain medicine, and proper care can help during recovery.

Episiotomy Recovery and Healing

Recovery from an episiotomy involves caring for the incision, managing discomfort, and paying special attention to the perineal area. Most stitches dissolve on their own, and daily activities may need some adjustments while the area heals.

Immediate Postoperative Care

After an episiotomy, doctors close the incision in the perineum using dissolvable stitches. These stitches do not need to be removed and usually dissolve within 1 to 2 weeks, though it can sometimes take longer.

Good hygiene helps lower the risk of infection. Patients should gently clean the area with warm water, especially after using the toilet. A squirt bottle, called a peri bottle, can be helpful. Patting dry rather than wiping prevents irritation.

Common Care Tips

• Wear clean, loose-fitting underwear.
• Change sanitary pads often.
• Avoid baths until stitches have mostly healed.

Doctors often advise women not to use tampons or have sexual intercourse for about six weeks. This reduces the risk of irritation or infection while the tissues recover. Gentle movements and avoiding strain, like heavy lifting, help prevent stress on the healing perineum.

Managing Pain and Discomfort

Pain and swelling around the incision are common in the days after birth. Over-the-counter medications like acetaminophen or ibuprofen can help reduce discomfort. For more severe pain, a doctor may suggest prescription medicine. Creams or ointments are generally not effective for an episiotomy wound. Ice packs wrapped in cloth can ease swelling. Sitting on a soft pillow or donut cushion may provide comfort.

Warm sitz baths, where only the hips and buttocks are soaked in warm water, can also help soothe the area. Bowel movements may be uncomfortable or cause worry after an episiotomy. A stool softener can help make this easier and prevent straining. Drinking plenty of fluids and eating high-fiber foods will also support regular, gentle bowel movements and comfort during recovery.

Stitches and Wound Healing

After an episiotomy, doctors use dissolvable stitches to close the cut in the perineum. These stitches usually dissolve on their own within a few weeks. Some soreness and irritation in the area are normal as healing takes place.

Proper care helps prevent problems like infection or slow healing. Keeping the area clean and dry is important. Pouring warm water over the stitches while urinating can help reduce pain. Over-the-counter pain relievers, ice packs, and sitz baths may help with comfort.

It is also normal to feel discomfort when sitting or walking for the first 2–3 weeks after delivery. Swelling and bruising around the stitches can occur. If pain, redness, swelling, pus, a bad smell increases, or if the stitches come apart, contact a doctor.

Tips for Episiotomy Stitches Care

• Change pads often.
• Wear loose cotton underwear.
• Avoid heavy lifting and straining.
• Wash hands before and after touching the area.
• Follow any instructions given by a healthcare provider.

Below is a simple table showing common symptoms and when to seek help:

Symptom	Normal	Needs Doctor’s Attention
Mild pain	Yes	If severe or gets worse
Swelling/bruising	Yes	If it increases or gets hard
Mild bleeding	Yes	Heavy bleeding or clots
Discharge	Clear or light pink	Yellow, green, or foul-smelling

Risks and Potential Complications

An episiotomy is a surgical cut made in the perineum during childbirth and comes with specific risks. While some people heal without major issues, others may face complications.

Possible Risks

• Bleeding: The cut can cause bleeding during and after birth.
• Infection: Bacteria can infect the stitched area.
• Pain and Swelling: Many feel pain or discomfort in the perineum for days or weeks.
• Pain During Sex: Some people feel pain during sex for a while after healing.
• Scarring: Scar tissue can develop where the cut was made.

• Severe Tears: Sometimes, the cut extends and causes a deeper tear involving the rectum or anal sphincter.
• Urinary and Fecal Incontinence: Injury to the pelvic floor or anal sphincter can make it hard to control urine or stool.

Complication	Description
Bleeding	Heavy bleeding from the cut.
Infection	Redness, swelling, or pus around the area.
Pain	Ongoing discomfort in the perineum.
Severe Tears	The cut extends to the rectum or sphincter muscles.
Incontinence	Difficulty controlling bladder or bowel movements.
Painful Sex	Discomfort during sexual activity.
Prolonged Healing	Slower recovery compared to natural tears.