Episiotomy

What is an episiotomy?

An episiotomy widens the opening of the vagina for childbirth. It is a 1- to 3-inch long (2 to 4 cm) cut made between the opening of the vagina and the rectum. The cut helps prevent tearing of the vaginal wall during the delivery of the baby.

When is it used?

An episiotomy is used:

• to avoid a more severe tear into the vagina and rectum
• in most forceps, vacuum extraction, and breech deliveries.

What happens during the procedure?

When the baby's head is stretching the opening of your vagina, your healthcare provider will numb the area of the vaginal opening with an anesthetic unless you have already been given a block for pain. Your provider will then make a cut (incision) between the opening of the vagina and the rectum.

After you deliver your baby, the healthcare provider will stitch the incision. The stitches will not need to be removed. They will gradually dissolve after about 10 days.

What happens after the procedure?

The cut should heal quickly, but you may have some pain and swelling. This can be relieved by:

• cloth-covered ice packs on the area of the cut to reduce swelling and pain
• warm tub baths 2 or 3 times a day for 20 minutes to help with the soreness (starting at least 24 hours after delivery)
• sprays or pads that contain a numbing medicine
• pain medicine (such as acetaminophen or ibuprofen).

Having sexual intercourse too soon can cause some pain. It is best to wait 4 to 6 weeks until the cut has fully healed and your healthcare provider says it is OK to have sex again. For the first few times, there may be some pain, but it should eventually go away.

What are the benefits of this procedure?

The benefits of an episiotomy are:

• It may prevent tearing of the area from your vagina into the rectum, especially with large babies.
• It may heal more readily than a jagged tear. (A jagged tear may later cause pain during sexual intercourse.)
• It may shorten the second stage of labor by relieving muscle tightness in this area.
• It may prevent stretching of your vagina or pelvic relaxation later in life (a condition in which the structures that support your bladder and rectum are weakened).
• It may prevent injury to the baby if the baby's head is too large, the shoulders are too wide, or you are having a breech birth (the baby coming out feet or bottom first).
• It may prevent a Keloid scar (thick, raised and painful scar).

What are the risks of this procedure?

Possible risks are:

• increased blood loss
• poor healing or infection of the cut
• pain after delivery
• pain when you have sex
• discomfort in the scar
• hematoma (blood collection) in the vagina.

When should I call my healthcare provider?

The episiotomy should feel better and hurt less each day. Call your healthcare provider if:

• The pain and swelling do not get better.
• You have an increase in discharge from the vagina.
• You have a fever over 100°F (37.8°C).