Episiotomy: When it's needed, when it's not
Medically reviewed on July 31, 2017.
An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth. Although an episiotomy 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.
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.
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. An extensive episiotomy might also contribute to fecal incontinence after childbirth.
The new approach
Routine episiotomies are no longer recommended. Still, the procedure is warranted in some cases.
Your health care provider might recommend an episiotomy if:
- Extensive vaginal tearing appears likely
- Your baby is in an abnormal position
- Your baby is large (fetal macrosomia)
- Your baby needs to be delivered quickly
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 it after delivery.
There are two types of episiotomy incisions:
- Midline or median incision. A midline or median incision is done vertically. A midline incision is the easiest to repair, but 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 is often more painful and might be more difficult to repair.
An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth. A midline or median incision (shown at left) is done vertically. A mediolateral incision (shown at right) is done at an angle. A midline incision is the easiest to repair, but 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 is often more painful and might be more difficult to repair.
The role of warm compresses and tissue massage
During the second stage of labor — when you're pushing — your health care provider might apply warm compresses or warm mineral oil to the tissue between your vaginal opening and your anus. This might soften the tissue and help prevent tears in the skin.
Although the evidence for warm compresses is stronger, some health care providers also massage the area between the vaginal opening and the anus as labor progresses. This is known as perineal massage.
Your health care provider might even recommend trying perineal massage at home after week 34 of pregnancy. To get started, wash your hands and rub a mild lubricant, such as K-Y jelly, on your thumbs. Place your thumbs just inside your vagina and press downward toward your rectum. Hold for one to two minutes. Then, slowly massage the lower half of your vagina. Repeat the massage once a day for 10 minutes at a time until delivery.
Healing from an episiotomy
If you have an episiotomy or tear during delivery, the wound might hurt for a few weeks — especially when you walk or sit. If the incision or tear is extensive, the tenderness might last longer. Any stitches used to repair the episiotomy will usually be absorbed on their own.
In the meantime, to promote healing:
- Soothe the wound. Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound.
- Take the sting out of urination. Pour warm water over your vulva during urination, and rinse yourself with a squeeze bottle afterward.
- Prevent pain and stretching during bowel movements. Press a clean pad against the wound when passing a bowel movement.
- Sit down carefully. Tighten your buttocks as you lower yourself to a seated position. Sit on a pillow or padded ring.
- Use medication as needed. Your health care provider might order prescription medications or recommend 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.
- Consider complementary treatments. Some research suggests that lavender might help relieve pain after a tear or episiotomy. If your health care provider approves, add a few drops of lavender essential oil to your bath water or apply the oil directly to the tissue between your vaginal opening and your anus.
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 of an infection.
Accept some uncertainty
Share your thoughts about episiotomy with your health care provider during your prenatal visits and again when labor begins. Remember, though, it's important 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.