Episiotomy

An episiotomy is a surgical cut (incision) made in the perineum. The perineum is the area of skin between the vaginal opening and the anus. An episiotomy helps to make the opening of the vagina larger to allow more room for the baby to fit through during childbirth. An episiotomy may help prevent complex tears in the vagina, vulva, perineum, and rectum. However, performing routine episiotomies has been shown to increase the rate of tears extending into the rectum. The decision to do an episiotomy is based on the judgment and experience of the caregiver. Also, the patient is typically given an informed consent form before the procedure that gives permission for the procedure to take place.

There are a number of reasons why an episiotomy may be helpful. An episiotomy may be helpful if:

  • The baby's shoulders or head are too large to fit well through the vaginal opening.

  • Complicated tearing is likely and an episiotomy will provide better results.

  • The baby is in fetal distress and needs to be delivered quickly.

  • The baby is premature.

RISKS AND COMPLICATIONS

An episiotomy should not be performed routinely as there are risks and complications involved. These include:

  • Bleeding.

  • Tearing.

  • Developing a collection of blood in the episiotomy area (hematoma).

  • Infection.

  • Painful scar tissue.

  • Extending the tear into the rectum.

  • Loss of bowel control.

  • Breakdown of the original repair (dehiscence).

  • Sexual dysfunction.

BEFORE THE PROCEDURE

If possible, discuss your birth plan with your caregiver. Ask any questions you may have about this procedure. Talk about your concerns and understand when an episiotomy is necessary.

PROCEDURE

There are several types of episiotomies and different ways the procedure can be performed. Typically, an episiotomy is done at the very end of a delivery and just before the baby is born. If needed, a numbing medicine will be injected into the perineum area. If an epidural was given, the numbing medicine may not be needed.

There are 2 types of incisions. The most common episiotomy incision is called a midline incision. This incision is made straight down between the vagina and the rectum. The other type of incision is a medial lateral incision. This cut is often directed downward but away from the rectum. This is done so that the cut does not tear into the anal sphincter.

Once the baby is born, and sometimes before the placenta is delivered, the episiotomy is closed. With the skin numb, the incision will be sewn with dissolvable stitches (sutures).

AFTER THE PROCEDURE

  • The sutures will dissolve on their own and do not need to be removed.

  • Medicine will likely be given for pain. The pain and discomfort will depend on the tear.

  • Ice may be given to place on the episiotomy area. This helps to numb the area and reduce swelling.

  • Frequent baths to keep the skin clean are recommended.

  • The typical healing time for an episiotomy is 4 to 6 weeks.