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Episiotomy

An episiotomy is a surgical incision of the perineum (the skin and muscles between the vulva and anus) to enlarge the vaginal opening during labor.

Reasons for episiotomy
Episiotomy has been routine for decades. Between 50% and 90% of women giving birth to their first child have an episiotomy. They are done to speed delivery and prevent tears to the vagina. The procedure was also thought to reduce trauma to the baby and protect the mother's vaginal muscles. However, a large study has shown that routinely cutting an episiotomy increases the risk of tears in the back of the vagina while it reduces tears in the front. For this reason, the World Health Organization, among other groups, now recommends that episiotomy be avoided unless it is absolutely necessary.

Episiotomies may be useful to:

  • prevent a serious tear if labor progresses too quickly
  • speed delivery when you or your baby are experiencing complications
  • ensure safe delivery of an extremely large or breech baby

Studies have shown that episiotomies do not heal better than a tear, and many women get through the birth process without a tear or an episiotomy. The number of deliveries you have had, the length of second (pushing) stage labor, and the size and position of the baby all may influence whether or not you have a tear.

You cannot always avoid an episiotomy but activities that strengthen the perineum may help. Such activities include Kegel exercises and perineal massage. Childbirth techniques to control breath and the urge to push also help.

The procedure
Just as your baby's head is about to crown, your health care provider will inject a local anesthetic in your vaginal opening and make an incision. The baby and then the placenta will be delivered through the enlarged opening. The incision will be stitched closed immediately after delivery.

Two types of incision are used. The median incision goes straight down the vagina toward the anus, and the medio-lateral incision is made at an angle from the vagina to the anus. The medio-lateral is considered less likely to tear through to the anus but is more difficult to repair and takes longer to heal than does the median.

Recovery
Healing may take several weeks but for most women it is uncomplicated. Applying ice packs immediately after the birth can speed the process.

Over the next few weeks, you should:

  • use sitz bath a few times a day
  • change your pads frequently
  • use a heat lamp or hair dryer after you bathe to keep the area around the stitches clean and dry
  • take stool softeners and eat lots of fiber to prevent constipation
  • do Kegel exercises: [squeeze the muscles that you use to hold in urine for five minutes, 10 times a day, during your regular activities]

To relieve pain and discomfort:

  • Take a warm bath (wait 24 hours postpartum)
  • Apply warm compresses, ice packs, or witch hazel to the affected area
  • Take ibuprofen or another nonsteroidal anti-inflammatory medications

Your body will absorb the stitches, so they do not have to be removed. You can resume light activities, office work or housecleaning, within a week after giving birth. For about six weeks, you should avoid sexual intercourse, tampon use, and any activity that might rupture the stitches.

Risks
Risks associated with episiotomy include:

  • Large tears
  • Excessive bleeding
  • Infection
  • Painful intercourse in the first few months after giving birth