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What is an episiotomy?

An episiotomy is an incision through the area between your vaginal opening and the anus. This area is called the perineum. It’s done to make the vaginal opening larger for childbirth.

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

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

Why might I need an episiotomy?

Not all women need an episiotomy. Stretching the tissues naturally may help reduce the 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:

  • Fetal distress
  • Complicated birth such as when the fetus is positioned bottom or feet first (breech)  or when the  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 urge 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 to 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 the fetal head stretches the vaginal opening, the health care provider will use surgical scissors or a scalpel to make the episiotomy incision.
  4. Your provider will deliver the baby followed by the placenta.
  5. He or she will check the incision for any further tearing.
  6. Your provider will use sutures to repair the perineal tissues and muscle. The sutures 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
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure

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