An episiotomy is a small surgical procedure done during labor. It is a cut made into the perineum, the skin, muscles, and area between the vagina and the rectum in order to enlarge the vaginal opening during delivery. An episiotomy is a commonly performed surgery during delivery. The incidence varies significantly among hospitals, doctors, and countries.
For decades, episiotomies have been routinely performed to help speed delivery during the pushing phase of labor and to prevent tears to the vagina, especially serious tears that may stretch to the urethra or the anus. An episiotomy was also thought to lessen trauma to the baby and protect the vaginal muscles.
However, most doctors now agree that episiotomies should no longer routinely be performed. One large study showed that routinely cutting an episiotomy increases the risk of tears in the back of the vagina, but reduces tears in the front. Based on these results, the World Health Organization, among other groups, recommends avoiding a routine episiotomy and to only perform it when it is indicated in the following circumstances:
- Fetal or maternal distress: To speed delivery if you or your baby are experiencing complications
- Large baby, especially the head: To ensure a safe delivery by widening the vaginal opening
- Uncontrolled pushing: When the perineum hasn't had enough time to stretch
- With an operative delivery: When forceps or a vacuum are used
If an episiotomy is needed, then just before your baby is born, as the head is about to crown, and after ensuring that there is adequate anesthesia, your doctor will make an incision between the vaginal opening and the perineum, the skin and muscles between the vagina and the rectal opening.
There are two types of episiotomy incisions:
Median episiotomy: The median incision goes straight down the vagina toward the anus
Medio-lateral episiotomy: This is made at an angle from the vagina to the anus. The medio-lateral is considered less likely to tear through to the anus but is more difficult to repair and takes longer to heal than the median.
An episiotomy is usually stitched closed immediately after delivery, and most doctors use stitches that will self-absorb.
Post Delivery Episiotomy Care
After delivery, try these tips for pain relief while the incision is healing:
- Washing the area using a squirt bottle with warm water instead of wiping
- Place cold packs on the perineum
- Use medicated pads such as Tucks
- Sitz bath: A portable bath with warm water to sit in which helps relieve pain and also heals the skin