An episiotomy can speed delivery. But is the procedure necessary?
An episiotomy is an incision made in the tissue between the vaginal opening and anus (perineum) during childbirth. Here's what you need to know about the procedure.
The episiotomy tradition
An episiotomy was once a routine part of childbirth. It was thought that an episiotomy would help prevent more extensive vaginal tears 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. In fact, routine episiotomies offer no benefits. Recovery is uncomfortable, and sometimes the surgical incision is more extensive than a natural tear would have been.
The new approach
Researchers say there's no need for a routine episiotomy, but the procedure is still warranted in some cases. For example, your doctor may recommend an episiotomy if extensive vaginal tearing appears likely, if your baby is in an abnormal position or if 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 won't feel the doctor making or repairing the incision.
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 (perineal massage) in the last weeks of pregnancy. 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 (K-Y jelly, Astroglide, others) on your thumbs. Place your thumbs inside your vagina and press downward toward your rectum. Hold for five to 10 minutes. Repeat once a day 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 had an episiotomy or tear during delivery, the wound may hurt for a week or so — especially when you walk or sit. If you had an extensive incision or tear, the tenderness may continue for two to three weeks. 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. Repeat throughout the day.
- 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 doctor.
Accept some uncertainty
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. Count on your doctor to respect your wishes about episiotomy — and to let you know when it's the safest option for you or your baby.
Last Updated: 06/21/2006
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