Episiotomy

What is an episiotomy?

An episiotomy is an incision (cut) made in the area between a woman's vagina (birth canal) and rectum. Women have this procedure during the second stage of labor. 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.

Why would I need an episiotomy?

An episiotomy makes your vaginal opening larger, so your baby can be born faster and more easily. An episiotomy may prevent the skin and muscle around your vaginal area and rectum from tearing while giving birth. You may need an episiotomy for the following reasons:

• Your baby is larger than your vagina can stretch. Your baby's shoulders may also be too wide for your vaginal canal.
  
  
• Your baby is moving down your vagina face down (facing your rectum).
  
  
• Your baby's heartbeat is slower than it should be, or he needs oxygen right away.
  
  
• Your baby needs to be delivered using forceps or a vacuum extractor. These tools help pull your baby out of your birth canal gently and quickly.

What happens during an episiotomy?

Your caregiver cleans the skin around your vagina. A shot of numbing medicine may be given into the skin where the cut will be made. You may still feel pressure or pushing, but you should not have pain. 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.

What happens after an episiotomy?

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. Your caregiver may give you medicine to take away or decrease your pain.

What are the risks of an episiotomy?

• 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.

How do I care for myself after an episiotomy?

• Sitting: Use a cushion when sitting to help decrease pain.
  
  
• Sitz baths: Your caregiver may suggest sitz baths to help decrease your pain, swelling, and bruising. During a sitz bath, you will sit in a bathtub filled with warm or cold water. A cold sitz bath may decrease your pain right away. To make a cold-water sitz bath, sit in slightly warm water and add ice cubes to the water. Stay in the sitz bath for 20-30 minutes, or as long as your caregiver suggests. Ask your caregiver for more information about sitz baths and other ways to decrease your pain.
  
  
• Wound care: When you can bathe or shower, gently wash your stitches with soap and water.
  
  
• Kegel exercises: You can do Kegel exercises by tightening and relaxing the muscles around your vagina. Kegel exercises help make the muscles stronger, and may prevent gas and urine from leaking out. Ask your caregiver for more information about how to do Kegel exercises.
  
  
• Sexual intercourse: Ask your caregiver when it is safe to have sex after your episiotomy. Your caregiver may tell you to wait 6 to 7 weeks before having sex. Caregivers may suggest using a lubricant (vaginal gel) to help prevent pain during sex.
  
  
• Tampon use: Your caregiver may say it is okay to use tampons when your pain is gone. Change tampons often, and use them only during the daytime. This may prevent you from getting a serious infection called toxic shock syndrome. Ask your caregiver for more information about tampon use.

Where can I find more information?

Contact the following:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

When should I call my caregiver?

Call your caregiver if:

• You are leaking urine or BMs.
  
  
• You have a hard, painful lump on, or near, your wound.
  
  
• You have bright red blood coming from your wound.
  
  
• Your pain does not go away, or gets worse.
  
  
• Your skin between your vagina and rectum is swollen, warm, or red.
  
  
• You have questions or concerns about your episiotomy, medicine, or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

• You are urinating very small amounts, or not at all.
  
  
• You have pus or yellow drainage coming from your wound.
  
  
• You have sudden trouble breathing.
  
  
• Your stitches come loose, or your wound breaks open.
  
  
• Your wound will not stop bleeding.

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.

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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.