What is an episiotomy? An episiotomy is an incision through the vaginal wall and the perineum (the area between the thighs, extending from the vaginal opening to the anus) to enlarge the vaginal opening and facilitate childbirth. During a vaginal birth, the health care provider will assist the fetus' head and chin out of the vagina when it becomes visible. Once the head is out of the vagina, the shoulders are eased out, followed by the rest of the body. In some cases, the vaginal opening does not stretch enough to accommodate the fetus. In this case, an episiotomy may be done to help enlarge the opening and deliver the fetus. The episiotomy is usually done when the fetal head has stretched the vaginal opening to several centimeters during a contraction. Although episiotomy was a very common procedure in the past, more recent studies have found that routine or preventive use of episiotomy does not benefit the health of mother or baby. The American College of Obstetricians and Gynecologists (ACOG) no longer recommends performing an episiotomy on a routine basis. Discuss with your health care provider the best treatment option for you and your baby. An episiotomy may be classified into two types: Midline or median. This refers to a vertical incision that is made from the lower opening of the vagina toward the rectum. This type of episiotomy usually heals well but may be more likely to tear and extend into the rectal area, called a third or fourth degree laceration. Mediolateral . This refers to an incision that is made at a 45-degree angle from the lower opening of the vagina to either side. This type of episiotomy does not tend to tear or extend, but is associated with greater blood loss and may not heal as well. After the delivery of the baby, the mother may be asked to continue to push during the next few uterine contractions to deliver the placenta. Once the placenta is delivered, the episiotomy incision is sutured. If a mother does not have regional anesthesia such as an epidural, a local anesthesia may be injected in the perineum to numb the area for repair of a tear or episiotomy after delivery. Other related procedures that may be used during labor and birth include caesarean delivery and external and internal fetal monitoring. Please see these procedures for additional information. Reasons for the procedure Not all women will require an episiotomy, and assisting the tissues to stretch naturally may help reduce the need for this procedure. If an episiotomy is not done, tearing of the perineal tissues may or may not occur. An episiotomy may be used to assist in the treatment of the following conditions: Fetal distress Complicated birth such as a breech presentation (bottom or feet first) or shoulder dystocia (when the fetal head has been delivered but the shoulders are trapped) Prolonged second stage (pushing stage of labor) Forceps or vacuum delivery Large baby Preterm baby There may be other reasons for your health care provider to recommend an episiotomy. Risks of the procedure As with any surgical procedure, complications may occur. Some possible complications of an episiotomy may include, but are not limited to, the following: Bleeding Tearing past the incision into the rectal tissues and anal sphincter Perineal pain Infection Perineal hematoma (collection of blood in the perineal tissues) Pain during sexual intercourse Peoples who are allergic to or sensitive to medications or latex should notify their health care provider. If the birth of the baby occurs too rapidly, an episiotomy may not be performed. There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the delivery. Before the procedure Your physician/midwife will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. The consent form for an episiotomy may be included as part of the general consent for your delivery. Notify your health care provider if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general). Notify your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking. Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure. Based upon your medical condition, your health care provider may request other specific preparation. During the procedure An episiotomy may be performed as part of a vaginal birth. The procedure and the type of episiotomy may vary depending on your condition and your health care provider's practices. Generally, an episiotomy follows this process: You will be positioned on a labor bed, with your feet and legs supported for the birth. If you have not been given any labor or delivery anesthesia, a local anesthetic may be injected into the perineal skin and muscle to numb the tissues before the incision. If epidural anesthesia is used, you will have no feeling from your waist down and no additional anesthesia will be needed for the episiotomy. During the second stage of labor (pushing stage), as the fetal head stretches the vaginal opening, the physician/midwife will use special scissors or a scalpel to make the episiotomy incision. The baby will be delivered. The placenta will be delivered. The episiotomy incision will be examined for any further tearing. A local anesthetic may be injected into the perineal skin and muscle to numb the tissues. The perineal tissues and muscle will be repaired using sutures, which will dissolve over time. After the procedure After an episiotomy, you may experience incisional pain. An ice pack may be applied immediately after birth to help reduce swelling and pain. During your stay in the hospital and at home after your baby’s birth, sitz baths (warm or cold shallow baths) may relieve soreness and speed healing. Medicated creams or local anesthetic sprays applied to your perineum may also be helpful. You may take a pain reliever for soreness as recommended by your physician. Be sure to take only recommended medications. You should keep the incision clean and dry, using the cleansing method recommended by your health care provider after urination and bowel movements. If bowel movements are painful, stool softeners recommended by your health care provider may be helpful. You should not douche, use tampons, or have intercourse until the time instructed by your physician/midwife. You may also have other restrictions on your activity, including no strenuous activity or heavy lifting. You may resume your normal diet unless your health care provider advises you differently. Your health care provider will advise you when to return for further treatment or care. Notify your health care provider if you have any of the following: Bleeding from the episiotomy site Foul-smelling drainage from the vagina Fever and/or chills Severe perineal pain Source
