An episiotomy is an incision through the vaginal wall and the perineum (the area between the thighs, extending from the vaginal opening to the anus) to enlarge the vaginal opening and facilitate childbirth.
During a vaginal birth, the physician/midwife will assist the fetus' head and chin out of the vagina when it becomes visible. Once the head is out of the vagina, the physician/midwife usually rotates the fetus to the side and eases the shoulders out, followed by the rest of the body.
In some cases, the vaginal opening does not stretch enough to accommodate the fetus. The physician/midwife may perform an episiotomy to help enlarge the opening and deliver the fetus. The episiotomy is usually performed when the fetal head has stretched the vaginal opening to several centimeters during a contraction. Although episiotomy was a very common procedure in the past, more recent studies have found that routine or preventive use of episiotomy does not benefit the health of mother or baby. The American College of Obstetricians and Gynecologists (ACOG) no longer recommends performing an episiotomy on a routine basis. Discuss with your physician the best treatment option for you and your baby.
An episiotomy may be classified into two types:
After the delivery of the baby, the mother is asked to continue to push during the next few uterine contractions to deliver the placenta. Once the placenta is delivered, the episiotomy incision is sutured. If a mother does not have regional anesthesia such as an epidural, a local anesthesia may be injected in the perineum to numb the area for repair of a tear or episiotomy after delivery.
Other related procedures that may be used during labor and birth include caesarean delivery and external and internal fetal monitoring. Please see these procedures for additional information.
Not all women will require an episiotomy, and assisting the tissues to stretch naturally may help reduce the need for this procedure. If an episiotomy is not performed, tearing of the perineal tissues may or may not occur. An episiotomy may be used to assist in the treatment of the following conditions:
There may be other reasons for your physician to recommend an episiotomy.
As with any surgical procedure, complications may occur. Some possible complications of an episiotomy may include, but are not limited to, the following:
Patients who are allergic to or sensitive to medications or latex should notify their physician/midwife.
If the birth of the baby occurs too rapidly, an episiotomy may not be performed.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician/midwife prior to the delivery.
Based upon your medical condition, your physician/midwife may request other specific preparation.
An episiotomy may be performed as part of a vaginal birth. The procedure and the type of episiotomy may vary depending on your condition and your physician/midwife’s practices.
Generally, an episiotomy follows this process:
After an episiotomy, you may experience incisional pain. An ice pack may be applied immediately after birth to help reduce swelling and pain. During your stay in the hospital and at home after your baby’s birth, sitz baths (warm or cold shallow baths) may relieve soreness and speed healing. Medicated creams or local anesthetic sprays applied to your perineum may also be helpful.
You may take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
You should keep the incision clean and dry, using the cleansing method recommended by your physician after urination and bowel movements. If bowel movements are painful, stool softeners recommended by your physician/midwife may be helpful.
You should not douche, use tampons, or have intercourse until the time instructed by your physician/midwife. You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.
You may resume your normal diet unless your physician/midwife advises you differently.
Your physician/midwife will advise you when to return for further treatment or care.
Notify your physician/midwife if you have any of the following:
Your physician/midwife may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.
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