Episiotomy
Reviewed by Dr. Jennifer Lincoln
Some women’s birth experiences are fast and straightforward, involving a series of contractions, a few rounds of pushing, and delivery. But childbirth is often more complicated and frequently involves some type of medical intervention. Research shows that more than 85 percent of women who deliver vaginally undergo an episiotomy or have some type of a tear.1
What it is
An episiotomy is an incision that makes the vaginal opening larger to facilitate a safer birth. Doctors began performing episiotomies routinely in the 1920s to reduce the amount of tearing and damage to the vaginal opening and perineum. The theory was that, by making a prophylactic incision, as opposed to allowing a tear to occur, healing would be faster and more seamless. It was also argued that the incision created by the intentional cut would be far easier to repair than a natural tear.
Recent research, however, has contradicted many of these theories. In fact, many practitioners now recognize that natural tears tend to heal faster and better than incisions. One study found that episiotomies did not decrease the chance of vaginal tears at all2. In fact, the American College of Obstetricians and Gynecologists (ACOG) no longer recommends episiotomies unless deemed absolutely necessary3. Since this change in recommendation, the rate of this procedure declined from 9.6 percent in 2016 to 7.8 percent in 20174.
Why it happens
The rates have dropped, but episiotomies are still performed during childbirth, and many for good reason. If your baby is larger or is in fetal distress, an episiotomy may be called for to speed along the birth process and prevent a higher degree of tearing.
During the episiotomy, you’ll be injected with a local anesthetic to reduce pain, especially if you were not previously given an epidural. Once you’ve made it to the pushing stage, your doctor will make an incision from your vaginal opening toward the perineum to expedite delivery. Once your baby is delivered, your doctor will repair the tear with stitches in a similar manner to repairs for other vaginal lacerations.
How to heal postpartum:
The process of caring for and healing from your episiotomy incision is similar to healing from a natural vaginal tear. While you’re still at the hospital, the nursing staff will offer you acetaminophen or ibuprofen, and will check on your incision to make sure that there are no signs of infection or irritation.
Once you leave the hospital, the real healing process begins. Your stitches will dissolve on their own, which can take up to six weeks. For several ways to help your body heal during that time, check out these postpartum perineal care recommendations.
EXPLORE POSTPARTUM PERINEAL CARE
Lay back and rest
For the first 24 hours, it is important to lie down for approximately 20 to 40 minutes each hour to reduce swelling and assist healing.
If you have lower-back pain, lying on your side is often more comfortable.
Wrap ice or a cold pack in a thin piece of dampened cloth, and apply it to the sore area for 10 to 20 minutes at a time, repeating each hour as necessary.
You can also put an ice pack in the inside lining of a sanitary pad, or use a frozen pad or diaper as a cold compress.
This is especially important in the first 24 hours to help decrease swelling and ease pain.
Shower or bathe every day. If you have a first- or second-degree tear, consider taking sitz baths after your first couple postpartum days.
Taking sitz baths—soaking your pelvic floor for 10 to 20 minutes several times a day—can help reduce irritation and swelling.
Studies show that cold sitz baths relieve pain more effectively than warm ones. Start with lukewarm water, and gradually add ice cubes.
Check with your physician before adding medications or epsom salts. After each sitz bath, dry any tears or stitches by gently patting them with a towel or using a hair dryer on cool.
With an extra-sensitive perineum, you cannot wipe as you normally would when using the bathroom. Instead, use a squeeze (or peri) bottle.
Hospitals often send mothers home with a peri bottle to help keep the area clean without friction. You can use this squirt bottle to wash away urine, feces, or anything containing bacteria that could induce irritation or an infection.
When finished, gently pat the area dry with baby wipes, medicated pads, or clean toilet paper.
Once the wound is healed, you can wipe gently from front to back.
Soak a pad in aloe and/or witch hazel, freeze it, and place it either between a sanitary napkin and your perineum or directly on the area for cooling relief.
Change your padsicle at least every four hours to reduce the risk of infection.
The “pelvic elevator” can help strengthen your pelvic floor while reducing perineal pain and swelling. Try a set of three of these exercises each hour.
- Imagine your pelvic floor is an elevator in a three-story building
- Sit upright on a chair and breathe in, lengthening your spine
- Hold your breath, and feel your pelvic floor squeeze, closing the elevator door
- Exhale
- Breathe in, keeping the elevator doors closed and lifting your pelvic floor to level two
- Exhale
- Breathe in as you lift your pelvic floor to level three
- Breathe out as you release your pelvic floor to ground level
When sitting, use a pillow, padded ring, or inflatable “donut” cushion for 30 or fewer minutes.
Making slight adjustments to your sitting position is important during this time to avoid blood pooling.
If you’ve undergone perineal repair, try to sit with your legs together rather than crossed.
Drink plenty of water to avoid constipation. Straining with bowel movements will stretch the perineum and can cause pain.
You can also avoid constipation by eating fiber-rich foods such as fresh fruits and vegetables.
Some signs that you may not be healing correctly are increased pain and bleeding at the incision site, as well as any raised skin, which could indicate swelling. If you notice any pus, foul smell, or fevers, this could be an indication of an infection, so it is important to bring this up with your practitioner. While bowel movements in the first few days after delivery are typically uncomfortable, if you start experiencing extreme pain with each bowel movement, this is another reason to contact your physician.
At the time of your six-week postpartum follow-up with your doctor, you should be well on your way toward recovery. This is a great time to discuss any concerns that you might be having and ask for advice on your healing journey.
References
1 https://pubmed.ncbi.nlm.nih.gov/25752310/
2 https://pubmed.ncbi.nlm.nih.gov/24529800/
3 https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-is-an-episiotomy#:~:text=The%20American%20College%20of%20Obstetricians,that%20may%20happen%20during%20delivery.
4 https://www.leapfroggroup.org/news-events/new-report-maternity-care-us-shows-encouraging-progress-reducing-episiotomies-none
Additional resources
RELATED READING
Postpartum conditions and complications
Even with the smoothest of births, it's normal to experience changes.
Vaginal tears
Even during the easiest vaginal deliveries, some type of tear is almost guaranteed.
Recovering from a vaginal delivery
Two-thirds of babies born in the United States are born through vaginal deliveries.