Episiotomy

Definition of Episiotomy

An episiotomy is a cut made to widen the opening of the vagina. It is done toward the end of labor to keep the vaginal tissues from tearing as the baby is born. Sometimes an episiotomy can also help the birth attendant to deliver the baby quickly if the baby is in distress.

Who is a candidate for the procedure?

Usually, the doctor or midwife attending the birth decides whether to do an episiotomy. An episiotomy may be done when:

• the vagina cannot stretch enough to allow the baby to pass through
• a baby is thought to be large, for example, more than 9 pounds
• monitors show that the baby may be in distress or not getting enough oxygen and needs to be born quickly
• the vaginal opening starts to tear as the baby's head appears
• the baby's shoulder is blocking the birth canal

Routine episiotomy is no longer a part of evidence-based maternity care. All episiotomies should be done for a specific indication.

How is the procedure performed?

As the crown of the baby's head pushes through the vaginal opening, an anesthetic is injected in the mother's perineum to numb it. The perineum is the skin area between the vagina and anus. A cut 2 to 3 inches long is made there. After the baby is born and the placenta is delivered, the cut is stitched up.

What happens right after the procedure?

What happens later at home?

Keeping the area clean is the key to preventing infection and to helping speed healing. The stitches will dissolve after a period of time and do not need to be removed.

To help heal an episiotomy, a woman should:

• take sitz baths or sit in a shallow tub of warm water a few times a day. Washing the area gently with a stream of water after using the bathroom is helpful.
• relieve pain and swelling with Tucks pads and ice packs. Sitting on an inflatable donut helps as well.
• avoid constipation to keep this tender tissue from stretching too much. Stool softeners, such as docusate (i.e., Colace, Peri-colace), 8 to 10 glasses of fluids each day help in this regard.
• use over-the-counter pain relievers, such as acetaminophen (i.e., Tylenol) or ibuprofen (i.e., Advil, Motrin), as needed.
• avoid sexual intercourse for 6 weeks after the birth.

A woman should see her birth attendant for follow-up visits to check on how the episiotomy is healing.

What are the potential complications after the procedure?

Very rarely, an episiotomy may extend into the rectum. More stitches than usual would then be required to repair the cut. The increased risks of this problem are:

• infection
• bruising
• the forming of a hole between the vagina and rectum that is called a fistula
• rectal incontinence of stool or gas