What You Should Know About Episiotomies


Many women receive episiotomies unnecessarily. Find out more about the reasons for episiotomies and how to heal from one.

What is an episiotomy?

“Episiotomy” is defined as the procedure wherein an incision is made in the perineum, between the vagina and anus, to increase the size of the vaginal opening during child birth. Although it was routinely performed a few years back, research today claims that natural vaginal tears heal better and have a shorter recovery time. For this reason, preference of episiotomies is coming down in obstetric practice.

An episiotomy is measured in degrees, with the most common one being a second degree tear, which just involves the skin between the vagina and the anus. The least common is a fourth degree tear, which involves extensive damage to the muscles between the vagina and the anus, resulting in faecal incontinence. These tears cannot heal naturally and will need to be surgically repaired.

Episiotomies are a fairly common procedure. Doctors perform episiotomies when they believe there is insufficient room for the baby to be born. The episiotomy is a deliberate cut made to the vagina, and in most cases, doctors believe that the episiotomy will keep a woman from having to endure a worse tear. To date, there is a lack of medical evidence to confirm that episiotomies are truly beneficial or necessary for laboring women.

Reasons for Episiotomies

There are numerous reasons that doctors administer episiotomies. For many years, doctors believed that an episiotomy would save a mother from various serious health complications, such as urinary and fecal incontinence, or help the baby by preventing shoulder dystocia, oxygen deprivation, and brain damage. However, research is increasingly discovering that this is not always the case.

Disadvantages of Episiotomies

Unfortunately, episiotomies have numerous disadvantages. Some common disadvantages of routine episiotomies include increased blood loss, risk of infection, damage to the pelvic floor muscles, and rectovaginal fistulas. Many women report pain from an episiotomy that lasts for weeks, and others are unable to breastfeed due to the pain. Some women find that an episiotomy can affect future births as well. It isn’t uncommon for women with episiotomies to tear in the place where they were cut when giving birth to another child later.

When are Episiotomies Necessary?

There are situations in which an episiotomy is a necessary procedure. For example, if a baby is in distress, an episiotomy may be beneficial for the child. However, when the episiotomy occurs because the woman may already be tearing from the birth, or because the doctor feels that stitching will be easier because of an episiotomy, it’s often considered an unnecessary procedure. According to the American College of Obstetricians and Gynecologists, episiotomies are often not necessary and should never be considered routine.

The following conditions warrant a perineal incision:

  1. baby needs to be delivered urgently
  2. baby is in an abnormal position
  3. baby’s head is too large for the opening
  4. baby is in distress
  5. need a forceps or ventouse assisted delivery
  6. mother is either tired or unable to control pushing

If an epidural is used as a pain relief option during birth, further anesthetic might not be required. Otherwise, a pudendal block will be used to numb the area before making an incision.

Healing from an Episiotomy

If a woman receives an episiotomy, there are steps that she should take to help the healing process. First, she should avoid touching the open wound. Touching her vaginal area could spread germs, bacteria, and lead to potential infections. The area also needs to stay clean, and avoiding soaps is also recommended. Ice packs can also help the area recover more quickly.

Ice packs can reduce swelling and make a woman feel a little bit more comfortable. Most hospitals will provide ice packs. Another way to speed recovery is to use a spray bottle during urination. Instead of using toilet tissue, squirting warm water on the wound can cleanse the area and prevent bacteria from spreading. Some women find that sitting on something soft such as a pillow can help reduce discomfort. However, some healthcare providers recommend sitting on a harder surface to reduce swelling.

To aid the healing process, here are few things you can do:

  • Soothe the wound: Applying cold packs on the perineum will help soothe the wound. Maxi pads with built in cold packs are available in stores. Chilled witch hazel pads also help and are available at pharmacies.
  • Rinse the area: Rinse the area with warm water using a squirt bottle each time you use the toilet. Sitting in a bath tub with warm water for a while also helps. Pat dry the wound instead of wiping.
  • Do not allow urine to sting: Urinating can sting. Squat rather than sit on the toilet seat, or sit in an angle to prevent urine flowing over your wound.
  • Avoid stretching during bowel movements: The first few bowel movements after an episiotomy can be uncomfortable. Although it might feel that your stitches may give way, this hardly ever happens. To relieve pressure, press a clean pad firmly against the wound as if to give support.
  • Use medication: Doctors might provide pain relief medications, which need to be taken according to the doctor’s instructions.
  • Keep an eye on infections: Sometimes, an episiotomy results in an infection. If you notice a pus- like discharge, the area feels warm to touch or is swollen and if there is unbearable pain, contact your doctor immediately.

While research today strongly favours natural tears to an episiotomy, there are some doctors who still very strongly support the procedure as they feel a surgical intervention is controlled and easier to repair than a spontaneous irregular tear. But remember to voice your opinion and state clearly in your birth plan that you wish to avoid it unless absolutely necessary. And if the procedure is unavoidable, follow the postpartum care to have a safe and fast recovery.

Reducing the Chances of an Episiotomy

There are things that a woman can do to reduce the likelihood of enduring an episiotomy. Some preventative measures include perineal massage, controlled pushing during labor, and warm compresses applied to the vaginal area during delivery. Kegels, which exercise the pelvic floor muscles, can also come in handy for preventing an episiotomy. Women who want to avoid an episiotomy should also carefully choose their caregiver. A caregiver with an episiotomy rate of less than 20% is ideal.

What Can You Do To Prevent An Episiotomy?

Softening the tissue is often recommended by healthcare providers. This can be achieved by doing a perineal massage about six weeks before your due date. After washing your hands well, take some olive oil or lubricant onto your thumbs. Place your thumbs just inside your vagina and press downward toward your rectum and hold for one to two minutes. Then, slowly massage the lower half of your vagina. Repeat the massage once a day for 10 minutes up until the delivery.

It might be difficult for a woman to do this on her own at this stage of pregnancy; therefore one might take the help of a partner.

Apart from a massage, doing Kegel exercises to strengthen pelvic floor muscles, giving warm compress and support during labour, avoiding a lying down position at the time of pushing are things that might help.