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Episiotomy: When it's needed, when it's not

An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth. Although the procedure was once a routine part of childbirth, that's no longer the case. If you're planning a vaginal delivery, here's what you need to know about episiotomy and childbirth.

Medically reviewed on Oct 23, 2018

The episiotomy tradition

For years, an episiotomy was thought to help prevent more extensive vaginal tears during childbirth — and heal better than a natural tear. The procedure was also thought to help preserve the muscular and connective tissue support of the pelvic floor.

Today, however, research suggests that routine episiotomies don't prevent these problems after all.

The new approach

Routine episiotomies are no longer recommended. Still, the procedure is sometimes needed. Your health care provider might recommend an episiotomy if your baby needs to be quickly delivered because:

  • Your baby's shoulder is stuck behind your pelvic bone (shoulder dystocia)
  • Your baby has an abnormal heart rate pattern during your delivery
  • You need an operative vaginal delivery (using forceps or vacuum)

How it works

If you need an episiotomy and you haven't had any type of anesthesia or the anesthesia has worn off, you'll likely receive an injection of a local anesthetic to numb the tissue. You shouldn't feel your health care provider making the incision or repairing the episiotomy, but recovery can be uncomfortable. Your healthcare provider will discuss different techniques for improving your comfort as you heal.

There are two types of episiotomy incisions:

  • Midline (median) incision. A midline incision is done vertically. A midline incision is easier to repair, but it has a higher risk of extending into the anal area.
  • Mediolateral incision. A mediolateral incision is done at an angle. A mediolateral incision offers the best protection from an extended tear affecting the anal area, but it is often more painful and is more difficult to repair.
Episiotomy

An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth. A midline (median) incision (shown at left) is done vertically. A mediolateral incision (shown at right) is done at an angle. A midline incision is easier to repair, but it has a higher risk of extending into the anal area. A mediolateral incision offers the best protection from an extended tear affecting the anal area, but it is often more painful and is more difficult to repair.

Episiotomy risks

Episiotomy recovery is uncomfortable, and sometimes the surgical incision is more extensive than a natural tear would have been. Infection is possible. For some women, an episiotomy causes pain during sex in the months after delivery.

A midline episiotomy puts you at risk of fourth-degree vaginal tearing, which extends through the anal sphincter and into the mucous membrane that lines the rectum. Fecal incontinence is a possible complication.

Healing from an episiotomy

Any stitches used to repair the episiotomy are usually absorbed on their own. You might take prescription medications or use an over-the-counter pain reliever or stool softener. However, pain-relieving creams or ointments haven't been found to be effective for episiotomy wounds.

While you're healing, expect the discomfort to progressively improve. Contact your health care provider if the pain intensifies, you develop a fever or the wound produces a pus-like discharge. These could be signs and symptoms of an infection.

Accept some uncertainty

Share your thoughts about episiotomy with your health care provider during your prenatal visits and when labor begins. Remember, though, to go into labor with an open mind. It'll take time for the baby to stretch the vaginal tissues to allow delivery, and sometimes the baby needs to be delivered before the vaginal tissues can stretch on their own.

Count on your health care provider to respect your wishes about episiotomy — and to let you know when it's the safest option for you or your baby.

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