An episiotomy (say
"eh-pih-zee-AH-tuh-mee") is a cut the doctor or midwife makes in the
perineum (say "pair-uh-NEE-um"), which is the area
vagina and anus. It is done to help deliver the baby
or to help prevent the muscles and skin from tearing.
The cut is
made just before the baby's head comes out of the birth canal. It is stitched
up after the birth.
When is an episiotomy needed?
There are times when
an episiotomy is needed—for example, if the baby's heart rate drops too much during
pushing or if the baby's position is causing problems. The decision cannot be
made until delivery. Episiotomies are more common with first-time deliveries.
Routine episiotomy is not recommended.
Experts say that episiotomy is usually not needed during most births.footnote 1
In the past, episiotomy was a very common part of
childbirth. Many doctors no longer do episiotomies routinely. But a few still
do. If you have a concern about this, talk to your doctor or midwife ahead of
Can you prevent perineal tears?
It's not uncommon
for the perineum to tear during birth. But there are steps you can take to help
prevent this:footnote 2
Pay attention to your position during labor.
Different positions may put less pressure on your perineum. You may feel more
comfortable sitting upright, lying on your side, or getting down on your hands
and knees, for example.
Talk to your birthing coach ahead of
time so you agree on when and how hard you should push.
someone provide perineal support. This means pushing against the perineum to
protect it from tearing as the baby's head stretches it. This is sometimes done
with a hot, moist cloth.
Practice perineal massage.
This type of massage may help make the tissue around the vagina more flexible and reduce the chance of having a perineal tear or an episiotomy.footnote 2
Recovery from an episiotomy or perineal tear
If you had an incision (episiotomy) or
a tear in the area between your vagina and anus (perineum)
during delivery, your doctor or nurse-midwife will repair it with stitches,
local anesthetic. An ice pack will be placed against
your perineum to ease pain and swelling.
Recovery from an episiotomy or tear can be uncomfortable or quite
painful, depending on how deep and long the incision or tear is. Pain typically
affects sitting, walking, urinating, and bowel movements for at least a week.
Your first bowel movement may be quite painful. An episiotomy or tear is
usually healed in about 4 to 6 weeks.
To reduce pain and promote healing:
Keep an ice pack on your perineal area.
Try an anesthetic spray.
sitz baths in a tub of warm, shallow
Take pain medicine. Some pain medicines can be constipating,
so ask your health professional for a formulation that includes a stool
Take stool softeners and drink lots of fluids to help
soften stools and ease pain.
Use warm water from a squeeze bottle
to keep the perineal area clean. Pat it dry with gauze or a sanitary wipe. Only
wipe your perineal area from front to back.