Episiotomy Overview

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.

Prior to Procedure

During a prenatal visit, talk to your doctor about the benefits and risks of an episiotomy.

Anesthesia

You may have local 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 © 2009 Nucleus Medical Media, Inc.

How Long Will It Take?

It is done quickly during childbirth.

Will It Hurt?

If you receive local or epidural 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.

Postoperative Care

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 .

RESOURCES:

American College of Nurse-Midwives
http://www.midwife.org/

American Congress of Obstetricians and Gynecologists
http://www.acog.com/publications/patient_education/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada (SOGC)
http://www.sogc.org/index_e.asp/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm/

References:

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: 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/EpisiotomyP71P75.html . Accessed June 4, 2008.

Thorp JM, Yowell RK. The role of episiotomy in modern obstetrics. North Carolina Med J. 2000;61:118-119.