Episiotomy
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Episiotomy

(Perineum Incision; Incision, Perineum)

Pronounced: ip-eez-ee-AWT-o-me

En Español (Spanish Version)

Definition

Episiotomy involves cutting the perineum. The perineum is the area of skin and muscle between the vagina and the anus.

Parts of the Body Involved

  • Vagina
  • Perineum

Reasons for Procedure

The goal is to make the vaginal opening larger during delivery, while trying to prevent vaginal tears.

While once very common, episiotomies are not done as routinely anymore. A review of over 34,000 vaginal deliveries found that the number of episiotomies fell from 70% to 19% over a 17-year period.

The procedure, though, 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 or if the baby is a breech (coming out buttocks or feet first)—to keep the baby safe
  • The doctor determines forceps are needed—to prevent vaginal tears

Risk Factors for Complications During the Procedure

  • Severe scar tissue in the area
  • Prior vulvodynia (chronic pain in the vulva)

What to Expect

Prior to Procedure

During a prenatal visit, discuss with your doctor the benefits and risks of an episiotomy. There is controversy over the use of this procedure, and it is no longer routine.

Anesthesia

You may have local, epidural, or spinal anesthesia before the procedure. After the baby is born, your doctor may give you local anesthesia before the incision is repaired.

Description of the Procedure

When the infant's head starts to stretch the vaginal opening, the doctor uses surgical scissors to make a 1- to 3-inch cut between the vagina and anus (called midline). Or, the cut may be made toward the side into the muscle nearby (called mediolateral), but this usually results in more pain and bleeding. However, some evidence suggests that the first method has a higher risk of severe vaginal tears.

Midline vs. Mediolateral Episiotomy

Nucleus factsheet image

© 2008 Nucleus Medical Art, Inc.

After Procedure

After delivery of the baby and placenta, your doctor will check for tears and close the incision with absorbable stitches. These stitches will dissolve in about 10 days. An episiotomy usually heals without problems.

How Long Will It Take?

Performed quickly during childbirth

Will It Hurt?

If you receive local or spinal anesthesia, you will not feel pain during the procedure. After, most women have discomfort and swelling. You may need to take pain medication.

Possible Complications

Short-term complications may include:

  • Bleeding
  • Infection
  • Bruising
  • Swelling
  • Difficulty controlling your bowels
  • Pain during intercourse

Average Hospital Stay

2 days (the usual stay for vaginal delivery)

Postoperative Care

Your stitches will dissolve and 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 difficult to sit or walk. Ways to ease pain include:

  • For the first 24 hours after delivery, apply ice packs, wrapped in a towel.
  • Shower and bathe to keep the area clean.
  • Do not strain when moving your bowels. Your doctor may ask you to take a laxative.
  • 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 pad, or medication 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 just hold the pads onto the area while you sit on the toilet.
  • To decrease pain, try tightening your buttock muscles.
  • When your doctor tell 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 4-6 weeks or until the wound is healed.

Outcome

The outcome of an episiotomy should be a safe birth. The cut usually heals without further treatment. When you feel ready, you can do your regular activities. Ask your doctor when you can resume sexual activity.

If you have any questions or concerns, talk to your doctor.

Call Your Doctor If Any of the Following Occurs

  • Episiotomy area has become hot, swollen, or painful
  • Pus-like discharge from the area
  • Continuing problems with urinary or fecal incontinence (loss of urinary or bowel control)

RESOURCES:

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

American College of Obstetricians and Gynecologists
http://www.acog.com/

Women's Health.gov
http://www.4woman.gov/

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. 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 March 2008 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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