(Perineum Incision; Incision, Perineum)
The perineum is the area between the vagina and the anus. It is made up of skin and muscle. An episiotomy is the cutting of the perineum.
Reasons for Procedure
The incision is made to make the vaginal opening larger during birth. It was once a common practice but is no longer routine. It may be needed if:
- The baby is premature]]> or otherwise fragile—to relieve some of the pressure on the baby caused by stretching the perineum
- The baby is large and the shoulders may be hard to deliver
- Forceps or a vacuum are needed to assist in the delivery
Some short-term complications may include:
- Difficulty controlling your bowels
Factors that may increase the risk of complications include:
- Severe scar tissue in the area
- Prior problems with chronic pain in the vulva
What to Expect
Prior to Procedure
During a prenatal visit, talk to your doctor about the benefits and risks of an episiotomy.
You may have local, epidural, or spinal anesthesia before the procedure. This usually depends on your wishes and what is appropriate to deliver your baby. After the baby is born, your doctor may give you local anesthesia before the incision is repaired.
Description of the Procedure
The infant's head will start to stretch the vaginal opening. The doctor will then use special scissors to make a 1-3 inch cut in the area between the vagina and anus.
After delivery of the baby and placenta, your doctor will close the incision with absorbable stitches.
Midline vs. Mediolateral Episiotomy
How Long Will It Take?
It is done quickly during childbirth.
Will It Hurt?
If you receive local or spinal anesthesia, you will not feel pain during the procedure. After delivery, most women have discomfort and swelling. You may need to take pain medicine to help control pain while recovering.
Average Hospital Stay
The usual length of stay for vaginal delivery is two days. An episiotomy will not extend your stay.
Your stitches will dissolve in about ten days. The cut will heal within about two weeks. There may still be some soreness until the skin gets its natural strength back. This could take up to six weeks. During that time, you may find it uncomfortable to sit or walk. Ways to care for your perineum include:
- For the first 24 hours after delivery, apply ice packs, wrapped in a towel.
- Shower to keep the area clean.
- Do not strain when moving your bowels. Your doctor may ask you to take a laxative or stool softener.
- Use a spray bottle of water to clean the area after going to the bathroom.
- Take a sitz bath (sitting in water) several times each day. Usually warm baths are used, but cold, iced baths may offer faster pain relief. Start with room-temperature water and add ice cubes. You may stay in the water for 20-30 minutes.
- Use spray, medicated pads, or medicine as directed by your doctor. For example, you may use chilled witch hazel pads that fit between a sanitary napkin and the area that was cut. You can also hold the pads onto the area while you sit on the toilet.
- When your doctor tells you to, do Kegel exercises]]> . Simply squeeze the muscles you use to stop the flow of urine. This strengthens the pelvic floor and can help the area heal faster.
- Avoid having sex, douching, and using tampons for 6 weeks or as directed by your doctor.
- Be sure to follow your doctor’s instructions .
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills, swelling, redness, pain that does not get better, or foul-smelling discharge or bleeding from the episiotomy site
- Pain that you cannot control with the medicines you have been given
- Continuing problems with loss of urinary or bowel control
American College of Nurse-Midwives
American Congress of Obstetricians and Gynecologists
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
Women's Health Matters
American College of Obstetricians and Gynecologists. Rate of episiotomy plummets over past two decades. Medem website. Available at: http://www.medem.com/ . Accessed April 9, 2003.
Carroli G, Belizan J. Cochrane Pregnancy and Childbirth Group. Episiotomy for vaginal birth [systematic review]. Cochrane Database Syst Rev . 2000;(2):CD000081.
Episiotomy. Medline Plus Medical Encyclopedia. US National Library of Medicine and the National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002920.htm . Accessed August 17, 2005.
Episiotomy: can you deliver a baby without one? Mayo Clinic website. Available at: http://www.mayoclinic.com/health/episiotomy/HO00064 . Updated June 2006. Access June 4, 2008.
Managing complications in pregnancy and childbirth: episiotomy. World Health Organization website. Available at: http://www.who.int/reproductive-health/impac/Procedures/Episiotomy_P71_P75.html . Accessed June 4, 2008.
Thorp JM, Yowell RK. The role of episiotomy in modern obstetrics. North Carolina Med J . 2000;61:118-119.
Last reviewed October 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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