Episiotomy

WHAT YOU SHOULD KNOW:

• An episiotomy is an incision (cut) made in the area between a woman's vagina (birth canal) and rectum. Pregnant women have this procedure done during the second stage of labor to make the vaginal opening larger. During the second stage of labor, the uterus (womb) contracts (squeezes) to push your baby out. The second stage of labor ends when your baby is born. Ask your caregiver for more information about labor and vaginal birth.
  
  
• You may need an episiotomy to prevent damage to your vaginal area. Damage can occur if your unborn baby is larger than your vagina can stretch. You may need an episiotomy if your caregiver uses forceps or a vacuum extractor during labor. These tools help pull your baby out of your birth canal gently and quickly. Caregivers may do an episiotomy if your unborn baby has a slow heartbeat or needs oxygen. Having an episiotomy may allow your baby to be born faster and more easily. An episiotomy may help prevent skin and muscle tearing in your vaginal and rectal area.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic response to the numbing medicine used during your procedure. Even with an episiotomy, you may still get a vaginal or rectal tear during the birth of your baby. An episiotomy may cause tissue weakness increasing your risk for a tear the next time you give birth. After an episiotomy, you may get a hematoma (bruise) near your wound that feels hard or painful. You may have swelling, and your wound may bleed. You may feel pain when having bowel movements (BMs).
  
  
• You may get a wound infection or abscess (infected pus pocket) under your skin. Your wound may break open and need to be closed again. A fistula (abnormal tissue opening) may form between your rectum and vagina. A fistula allows gas and BMs to enter your vagina. You may get cellulitis, which is a skin infection in the area of your wound. An infection may lead to necrotizing fasciitis (tissue death), and can be life-threatening.
  
  
• Without an episiotomy, your skin and muscle may tear near your vagina and rectum while giving birth. These tears can be hard to fix and close with stitches. Vaginal and rectal tears may not heal as well as a cut. You may have bruising, bleeding, and get an infection at the site of the tear. You may leak urine. A tear into your rectum can make it hard for you to hold in gas or BMs. Vaginal tears may also cause sex to be very painful in the future. If your unborn baby is in danger, it may take longer to push him out without an episiotomy. Talk to your caregiver if you have questions or concerns about your episiotomy.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Local anesthesia: This is medicine to make you more comfortable during your procedure. It is a shot of medicine put into the skin where your episiotomy will be done. It is used to numb the area, and dull your pain. You may still feel pressure during the procedure after you get this medicine.

During your procedure:

Your caregiver cleans the skin around your vagina. Your caregiver makes a small cut through the skin and muscle between your vagina and rectum. The cut may be made downward toward your rectum, or sideways toward one of your legs.

After your procedure:

After your episiotomy is done and your baby is born, you will push out the placenta (afterbirth). The placenta supplies food and oxygen to your unborn baby in your uterus during pregnancy. Your caregiver will then close your cut with stitches. Do not get out of bed until your caregiver says it is okay.

• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.