Episiotomy

An episiotomy is a surgical incision made in the perineum, (the area of skin between your vagina and anus) to enlarge the vaginal opening for a baby’s head to emerge.

Although it was once the norm in childbirth, there’s much debate about whether having an episiotomy helps or not – some experts believe a perineal tear is preferable to a cut, and research does suggest that tears heal faster and have less likelihood of complications.

But while episiotomies are no longer routine, there are reasons you may need to have one – for example, if you have a large or breech baby, an assisted delivery with forceps or vacuum extraction or your baby gets stuck in the birth canal.

How is it done?

If you haven’t already had an epidural, your perineal area will be numbed with an injection of local anesthetic. The cut may be either a midline cut, which is straight down towards the rectum; or a mediolateral cut, which is angled to one side, away from the rectum. Even though the midline cut is easier to repair, and causes less discomfort, doctors tend to favor the mediolateral cut because it’s less likely to cause damage close to the rectum.

Dissolving stitches are usually used, so you shouldn't have to return to the hospital to have them removed. The stitches should heal in around three to four weeks after the birth. Talk to your healthcare provider about activities you should avoid during the healing period.

How painful is it?

An episiotomy is performed in the final stages of labor and is unlikely to compete with the pain of a contraction. The area will be numbed while the procedure is performed and most women report that they didn't feel pain at all – in fact some women say it’s a huge relief as it allows their baby to be born almost immediately.

What about afterwards?

You’ll probably feel some pain once the cut has been stitched. There are a number of ways you can help yourself:

Do your Kegel exercises
These increase circulation to the tender area and speed up healing.
Try a cool pack
Hold a cold ice pack on the stitches to take down any swelling (a wrapped bag of frozen peas is ideal).
Have a warm bath
This can soothe the area. You might also want to try a herbal sitz bath (your hospital will provide you with a sitz bath or you can get them at most drugstores), or a lavender or salt water bath. Be careful to pat dry the stitched area with a towel rather than rubbing it. Some women report using their hairdryer on a cool setting to dry the stitches!
Dilute your wee
Dribble a cup of tepid water over yourself as you pee, and be sure to wipe carefully from front to back.
Walk around
Walk around as much as possible after the birth to speed up the healing process.
Get some fresh air
Let air get to the stitched area – go ‘commando’ for as long as you can each day.
Invest in a rubber ring
If sitting on pillows or cushions still hurts, try sitting on an inflatable rubber ring.

Avoiding an episiotomy

Many women swear by perineal massage from six to eight weeks before their due date, so that the perineum is used to being stretched before labor.

Your perineum is located just below your vagina and just above your rectum, and is a stretchy piece of skin.

Make sure your hands are clean and any jagged nails are trimmed beforehand. Apply olive oil or sweet almond oil (don’t use any mineral-based oils, such as petroleum jelly) to the base of your vagina and your thumbs and insert your thumbs into your vagina as far as the first knuckle. Now gently massage and stretch the tissues until you feel a slight burning sensation. Repeat the procedure every day.

Of course, you can always ask your partner to do this for you, which might result in alot more fun for both of you, and will certainly take your mind of episiotomies for a while!

It may also be possible to reduce your risk of needing an episiotomy by laboring in an up right position. Standing or squatting are good positions to try. A warm compress applied to the perineal area can also help.

Lots of women worry about episiotomies and how much they will hurt. They can be painful, especially in the first days after the delivery, but they also heal very quickly. Your OB-GYN or nurse-midwife will only perform an episiotomy if they think it’s necessary.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.