Episiotomy: When it's needed, when it's not

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Episiotomy: When it's needed, when it's not

An episiotomy is an incision made in the tissue between the vaginal opening and anus (perineum) during childbirth. Although an episiotomy was once a routine part of childbirth, that's no longer the case. If you're planning a vaginal delivery, here's what you need to know about episiotomy and childbirth.

The episiotomy tradition

For many years, an episiotomy was thought to help prevent more extensive vaginal tears during childbirth — and heal better than a natural tear. The procedure was also thought to reduce the risk of incontinence after childbirth and keep the bladder and rectum from drooping into the vagina.

Sounds reasonable, but researchers have found that routine episiotomies don't prevent these problems after all. Recovery is often uncomfortable, and sometimes the surgical incision is more extensive than a natural tear would have been. For some women, an episiotomy causes pain during sex in the months after delivery. An episiotomy also may increase the risk of fecal incontinence after delivery.

The new approach

Researchers say there's no need for a routine episiotomy, but the procedure is still warranted in some cases. Your health care provider may recommend an episiotomy if:

  • Extensive vaginal tearing appears likely
  • Your baby is in an abnormal position
  • Your baby needs to be delivered quickly

If you need an episiotomy, you'll receive an injection of a local anesthetic to numb the tissue if you haven't had any other type of anesthesia or your anesthesia is no longer numbing the area. You're not likely to feel your health care provider making the incision or repairing it after delivery.

Episiotomy

An episiotomy is an incision made in the tissue between the vaginal opening and anus (perineum) during childbirth. A midline incision (shown at left) is most common, but sometimes a mediolateral ...

Illustration of an episiotomy 

The role of tissue massage

To soften the vaginal tissues for delivery, some health care providers suggest massaging the area between the vaginal opening and anus in the last weeks of pregnancy. This is known as perineal massage. Although there are no guarantees — and you don't have to do it if the idea makes you uncomfortable — stretching the tissues may reduce vaginal trauma during delivery.

Start by washing your hands thoroughly with soap and hot water. Make sure your nails are trimmed. Then 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. Then, slowly massage the lower half of your vagina. Repeat the massage once a day for 10 minutes at a time until delivery.

Your partner can help, if you wish. It's normal to feel a little burning or other discomfort as you stretch your perineum. Stop if you feel sharp pain.

Healing from an episiotomy

If you have an episiotomy or tear during delivery, the wound may hurt for a week or two — especially when you walk or sit. If the incision or tear is extensive, the tenderness may last longer. Any stitches used to repair the episiotomy will usually be absorbed on their own. In the meantime, you can help promote healing:

  • Soothe the wound. Use an ice pack, or wrap ice in a washcloth. Chilled witch hazel pads may help, too. Witch hazel is the main ingredient in many hemorrhoid pads. You can find witch hazel pads in most pharmacies.
  • Keep the wound clean. Use a squirt bottle to rinse the tissue between the vaginal opening and anus with water after using the toilet. Soak in a warm tub.
  • Take the sting out of urination. Squat rather than sit to use the toilet. Pour warm water over your vulva as you're urinating.
  • Prevent pain and stretching during bowel movements. Hold a clean pad firmly against the wound and press upward while you bear down. This will help relieve pressure on the wound.
  • Sit down carefully. To keep your bottom from stretching, squeeze your buttocks together as you sit down. If sitting is uncomfortable, use a doughnut-shaped cushion to ease the pressure.
  • Do your Kegels. These exercises help tone your pelvic floor muscles. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Starting about a day after delivery, try it for five seconds at a time, four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Aim for at least three sets of 10 repetitions a day. You can do Kegels while standing, sitting or lying down — even while breast-feeding your baby.
  • Use medication as needed. Your health care provider may order prescription medications or recommend an over-the-counter pain reliever or stool softener.
  • Look for signs of infection. If the pain intensifies or the wound becomes hot, swollen and painful or produces a pus-like discharge, contact your health care provider.

Accept some uncertainty

Share your thoughts about episiotomy with your health care provider during your prenatal visits and again when labor begins. Remember, though, it's important to go into labor with an open mind. It will take time for the baby to stretch the vaginal tissues to allow delivery, and sometimes the baby needs to be delivered before the vaginal tissues can stretch on their own. Count on your health care provider to respect your wishes about episiotomy — and to let you know when it's the safest option for you or your baby.

Last Updated: 2010-06-19
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