The babies’ heads are quite large. When you give birth, there’s a good chance your vagina will tear. Many lacerations are minor and heal without any problems, but about a third of women have lacerations severe enough to need to be stitched up.
The idea of having an episiotomy, in which vaginal tissues are intentionally cut, may seem like a lot, but there are situations where it’s the best course of action, including the need to prevent a larger and deeper spontaneous laceration.
Understanding why an episiotomy might be necessary and knowing how to take care of your episiotomy can help you come more prepared for this eventuality.
So let’s see everything there is to know about the procedure, including the risks, post-op care, and recovery tips.
What is episiotomy during childbirth
The word episiotomy comes from the Greek and means ;cut in the public region;. An episiotomy is a planned cut of the perineum (the area of skin between the vagina and anus) during the last stages of labour. Cutting this skin essentially makes the vagina bigger, making delivery easier and reducing the risk of it being late.
When an episiotomy is needed during delivery
Childbirth causes some form of damage to the vaginal wall in approximately 85% to 90% of women. Most lacerations are small, heal quickly, and resolve on their own in a short time. In other cases these lacerations are deeper and more serious and can lead to long-term problems for the woman.
An episiotomy, in which tissue is carefully cut to allow for the outlet to widen for the baby, is often thought to be better than letting a large laceration happen naturally. Furthermore, the risks that an episiotomy can entail for the baby are lower than the risk of damage due to a delivery after the term.
You may need to perform an episiotomy in the following situations:
- the vaginal tissues are not stretching enough to deliver the baby’s head and there is a risk of severe tearing.
- to be born, the fetus needs an assisted delivery with suction cup and forceps;
- delivery must take place quickly and cannot be delayed;
- you have a breech birth.
An episiotomy is performed in about one in seven deliveries and the choice to have the surgery. Before labor it is impossible to say for sure who will need to have one. There are however some women who are more at risk:
- primipare
- women carrying large or malpositioned fetuses
- older women
- women who have scar tissue from previous tears and episiotomies
How an episiotomy is performed during childbirth
If an episiotomy needs to be done, your midwife or doctor will discuss it with you and explain the reasons. They will only proceed with your consent.
The vaginal area will be cleaned and local anesthetic will be injected into the tissue that will be cut. Sterile scissors will be used to make a clean cut into the tissue, starting from the back of the vagina.
After delivery, the cut will be stitched up using stitches. Again, a local anesthetic will be used, so you won’t feel any pain.
Following the stitching it will be important that you take care of the wound to prevent it from becoming infected. Most episiotomy wounds heal completely within four weeks, in the meantime you may feel some discomfort, which you can try to relieve by the following ways:
- sit in a cool bath for a few minutes;
- hold an ice pack against the wound, but never apply it directly to the skin;
- lying down, standing too long in the early stages can cause tissue to swell and stitches to pull;
- take some paracetamol;
Risks of an episiotomy
Episiotomies are performed only when needed and when the risks of the surgery are less than the risks of not having one.
Some complications of an episiotomy include:
- episiotomy wound infection;
- poor wound healing;
- pain in the perineum;
- significant reduction in pelvic floor tone;
Prevent an episiotomy
There is some evidence that women who use techniques to improve tissue elasticity before going into labor have a reduced chance of needing an episiotomy.
Even some positions can prevent the use of an episiotomy during labor. Specifically, it would be better to favor lateral positions, on all fours, semi-extended.
During labor, it’s important to listen to and follow the instructions given by your midwife. Remember then, that just because you had an episiotomy during one birth doesn’t necessarily mean you’ll need it during further births.
Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.
She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.