An Introduction to Episiotomy

What is an episiotomy?

An episiotomy is a surgical incision that is made in the perineal area and the posterior wall of the vagina. It is primarily performed to enlarge the opening to enable the baby to pass and to prevent more significant soft tissue injuries, such as tearing in the birth canal (including the anal sphincter and rectum) during labor. The use of episiotomies is being reduced in many parts of the world unless they are clinically needed.

Some indications for an episiotomy include:

• Increased risk of deep tears in the tissues of the perineum, anal sphincter and/or urethra (for example, during rapid labor)
• The need to shorten the period of labor
• Perineal muscle weakness
• A large fetus
• Perineal edema
• The need for instrumental delivery (vacuum extraction or forceps)
• Fetal bradycardia 

How is an episiotomy performed?

An episiotomy may be performed centrally or laterally using a scalpel or scissors. The type of episiotomy depends on the experience and qualifications of the doctor or midwife performing the procedure, in addition to the specific anatomical features of the woman’s perineum.

After birth, the incision site is sutured under local anesthesia. Stitches are removed on the day of discharge from the hospital or are naturally absorbed by the body within weeks of the procedure. 

Best care for the episiotomy and stitches

The healing process for an episiotomy is usually fast and complication-free, especially when compared to potential severe vaginal tears that may occur in its absence.

In the first days after childbirth, the nurses will care for your suture and episiotomy wound. However, to promote quicker recovery with a reduced risk of infection, you must follow several guidelines when caring for the episiotomy incision:

• Rinse vulva and perineum after each urination and bowel movement. You can use a peri bottle to do this.
• Wipe the genitals dry and lie naked on a disposable absorbent sanitary napkin.
• Replace the sanitary napkins every three to four hours to avoid the growth of pathogenic bacteria.
• Apply ice to the perineum on top of the cloth (bottles with frozen water can be used) for 10–15 minutes several times a day.
• Avoid exerting any stress on the wound: do not sit on hard surfaces, do not lift weights, and do not forget about hygiene.
• After removing the sutures, take a soothing bath with warm water.
• Eat as much high-fiber plant foods as possible to help digestion. 

An episiotomy wound will take a few weeks to heal

Generally, it will take an average of three to five weeks for an episiotomy wound to heal. Within six weeks, your episiotomy should be completely healed. If you feel any discomfort or irritation, or see a discharge from the episiotomy wounds, make sure you visit your gynecologist to make sure everything is OK. 

There are a few reasons you might want to avoid an episiotomy

There are a few potential post-procedure complications you should be aware of. The main ones are postpartum pain, incontinence, and even sexual dysfunction. There are studies that suggest that episiotomy surgery itself can actually cause all of these problems. Additional complications include:

• Infection, such as could potentially occur with any surgical procedure
• Swelling and itching of the perineum or around the episiotomy area
• Bleeding, which may occur during the recovery period after the episiotomy with appearance of microcracks at the incision site
• Damage to the muscles or nerve endings of the perineum that usually goes away with proper rest. But sometimes a physical therapist’s intervention is required
• Painful sensations during movement, bending, and even simple sitting. Discomfort can last for several months after giving birth, or even for a whole year
• Painful sexual intercourse 

Techniques for avoiding an episiotomy

You can increase your chances of avoiding an episiotomy, especially in cases where you and your baby are healthy, and your baby is of a normal weight and head circumference.

It has been found that pelvic strengthening using Kegel exercises, being active during pregnancy, proper breathing, and effective pushes in labor, as well as a positive attitude, are good measures to prevent an episiotomy.

Another thing you can do is a perineal massage in the weeks before childbirth. Perineal massage has an important benefit, which is to increase the elasticity of muscles of the perineum. This allows greater stretching of the muscles and increases the size of the vaginal opening during labor and is shown to reduce the chances for an episiotomy. Additionally, perineal massage during labor is recommended by many organizations including the World Health Organization. If your healthcare professional supports it, add your favorite perineal massage oil to your maternity checklist.

Read The Ultimate Guide for Perineal Massage

Additional resources:

1. https://www.nhs.uk/conditions/pregnancy-and-baby/episiotomy/
2. https://americanpregnancy.org/labor-and-birth/episiotomy/