Episiotomy

A surgical incision made to enlarge the opening to the vagina during childbirth; it may prevent lacerations and tearing.

Parts of the Body Involved

Vagina, perineum (the area from the vagina to the anus)

Reasons for Procedure

An episiotomy is most often performed for the following reasons; however some of these are controversial within the medical community:

When the tissue does not stretch sufficiently and blocks delivery
To prevent tearing and lacerations, which some practitioners believe to be more difficult to heal than a straight surgical incision
To speed delivery
To make delivery easier in the case of a breech birth
When forceps are needed
When a woman has a pre-existing medical condition that could be adversely affected by a prolonged delivery
When there is an indication of fetal distress
To protect the babys head from additional trauma

Risk Factors for Complications during the Procedure

Severe scar tissue in the area
A large condyloma (a wart-like growth on the skin of the perineum), which bleeds if cut

What to Expect

Prior to Procedure - During a prenatal visit, discuss with your practitioner the potential benefits and risks of an episiotomy. Episiotomy was once considered routine in the U.S., but its use has become more controversial.

During Procedure - An episiotomy is done during childbirth. The use of fetal monitoring, anesthesia, and other medical monitoring and interventions varies among women.

Anesthesia - Could be local, epidural, or spinal, if any

Description of the Procedure - During the second stage of labor when the infants head starts to stretch the vaginal opening, the practitioner uses surgical scissors to make a 1 to 3-inch incision between the vagina and rectum. Alternately, the incision may be made toward the side, but this method usually results in additional pain and bleeding. After the child is delivered, the practitioner examines the area for additional tears and closes the incision with absorbable stitches. These stitches will dissolve in about 10 days

After Procedure - After delivery of the baby and placenta, your practitioner will check the area for tears and close the incision with stitches.

How Long Will It Take? An episiotomy is performed quickly during childbirth.

Will It Hurt? If you receive local or spinal anesthesia, you will not feel pain during the episiotomy. Most women report discomfort and swelling afterward, therefore a mild pain medication may be recommended.

Possible Complications:

Excessive bleeding or hematoma formation (a pooling of blood under the skin)
Infection
Delayed healing
Pain during intercourse
Damage to the rectal sphincter or rectum
Swelling that makes urination difficult
Injury to the fetus

Average Hospital Stay: 1-2 days after delivering your baby

Postoperative Care:

Apply ice packs, wrapped in a towel, for the first 24 hours after delivery.
Keep the area clean with regular showering or bathing.
Do not strain when moving your bowels; your practitioner may recommend that you use a laxative for several days after delivery.
Consider using a spray bottle of water to clean the area after going to the bathroom.
Take a sitz bath (soaking the area in water) several times each day. Warm sitz baths traditionally have been used. But recently cold, iced sitz baths have gained in popularity, as they provide faster pain relief. To avoid sitting in icy water, start with room-temperature water and add ice cubes. You may stay in the water for 20 or 30 minutes.
Use a spray, a medicated pad, or medication as recommended by your practitioner.
Try tightening your buttock muscles before sitting to decrease pain.
Begin performing Kegel exercises as soon as your practitioner recommends.
Refrain from sexual intercourse, douching, and using tampons for 4-6 weeks or until the wound is completely healed and you have no discomfort from it.

Outcome

The episiotomy incision usually heals in seven to 10 days without further treatment. You may resume many of your regular activities as tolerated. If you have any questions, problems, or concerns once you've returned home, contact your practitioner or discuss them at your 2-week postpartum check-up.

Call Your Doctor If Any of the Following Occurs

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Incontinence of urine or feces
Foul smelling vaginal discharge