What is Episiotomy?

In this post, we’re going to take a look at episiotomy. We’ll touch on how common episiotomies are, why they happen and how they are performed. We’ll also take a look at what recovery from episiotomy looks like. Read on to find out more...

episiotomy written as a dictionary definition

During childbirth, your healthcare professional may need to make a small cut to the area between the vagina and the anus (called the perineum). This procedure is called an episiotomy and helps facilitate childbirth by making the vagina a little wider, allowing the baby to come through more easily. If the procedure is not performed, an individual’s perineum may tear as their baby comes out. An episiotomy can help prevent a tear or speed up the delivery if the baby needs to be born quickly.

How common are episiotomies and tears?

If you’ve experienced episiotomy or perineal tearing you’re not alone! Figures show that 9/10 first-time mothers who have vaginal delivery will have some form of tear, graze, or an episiotomy. In the US it’s estimated that around 12% of births involve an episiotomy. Episiotomy is a routine procedure, however, it should only be performed when absolutely necessary and the birth appears to fit the criteria below.

Why might you be offered an episiotomy?

The National Institute of Healthcare Excellence (NICE) recommends that an episiotomy might be performed if:

  • The baby is in distress and should be born quickly, or
  • There is a need for forceps or vacuum (ventose), or
  • There is a risk of a tear to the anus

If your baby develops a condition known as fetal distress (an increase or decrease in their heart rate during labor), an episiotomy might be recommended. This is because your baby might not be getting enough oxygen and therefore it's better for it to be born quickly, reducing injuries or the risk of stillbirth. 

You might also be offered an episiotomy to widen the vagina so that some instruments used to facilitate birth (such as forceps) can be used effectively. Instruments may be used if:

  • You’re having a breech birth, where the baby is being born with their bottom or feet first
  • You have been in labor for many hours and no longer have the energy to push
  • You have a serious health condition (such as heart disease) and quick delivery is recommended to reduce risks to your health

Preventing perineal tear during childbirth

Your healthcare professional can help avoid tearing during birth when the baby's head becomes visible. Your healthcare professional may ask you to stop pushing and to pant a few quick short breaths so that the baby's head can emerge slowly. This will give more time for the perineal muscles to stretch and reduce the chance of tearing. 

Massaging the skin of the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during childbirth. This can be achieved by inserting 1 or 2 fingers into the vagina and applying gentle downward or sweeping pressure towards the perineum each day. 

How is an episiotomy performed?

Although it may sound alarming, an episiotomy is a simple procedure. Local anesthetic is used to numb the area and if you have already had an epidural, this can be topped up before the procedure is performed. When possible, your healthcare professional will make a small diagonal cut from the back of the vagina, directed down and out to one side. Once your baby has been born, the cut is stitched together using dissolvable stitches.

Episiotomy and tear recovery

Following birth, cuts are usually stitched within an hour. You may notice a lot of blood, but this should stop with the stitches and pressure. Stitches should heal within a month and it's important to discuss what activities you can and cannot do during this period.

If you’re in pain, talk to your healthcare professional about what painkillers you could take to help. It's important to remember that some painkillers are not suitable if you are breastfeeding so check with your healthcare professional beforehand. Other tricks to try and manage the pain include:

  • An ice pack or ice cubes wrapped in a towel placed onto the cut - avoid putting the ice directly onto your skin as this may cause more damage
  • Exposing the stitches to air as this can help the healing process - if possible take some time out to lay down on a towel for around 10 minutes once or twice a day to allow fresh air to circulate
  • The pain should not last more than 2 to 3 weeks - if it continues for longer, speak to your healthcare professional

A few individuals may experience excessive, itchy raised scar tissue where the cut or tear appeared. If this causes issues for you, be sure to get in touch with your healthcare professional.

Going to the toilet

This can be daunting given all the events of birth so it's an important topic to address. Whilst urinating try pouring some warm water over the outer area of your vagina as this might help to ease discomfort. Squatting over the toilet instead of sitting on it may help reduce stinging..

When defecating, you may find it useful to place a clean pad on the cut and press gently to relieve pressure from your stools on the cut. When wiping, it's business as usual with extra care to be gentle and go from front to back to prevent bacteria from the anal area infecting the cut. If it’s particularly painful, laxatives may help to make the stool softer and easier to pass.

Infection

If you suspect an infection, talk to your healthcare professional immediately. Symptoms of an infection in the area may include:

  • Red, swollen skin
  • Discharge from the cut
  • Persistent pain 
  • An unusual smell

Having sex after episiotomy or tear

Firstly it's important to point out that there is no right or wrong decision about when or how to start having sex after birth. It’s common to feel sore and tired whether or not an episiotomy or tear has occurred. Therefore, there's no need to rush! Pain in this area can be a sign that your body needs more time to heal. 

If you’ve had a tear or episiotomy its common to experience pain during sex for the first few months. If penetration is painful, it's important to communicate this with your partner and take your time. There are many other types of sex that do not involve the area which is healing. If pain during sex remains after the healing is complete, its best to discuss this with your healthcare professional.

It's important to remember that it’s possible to get pregnant as soon as three weeks after giving birth. For this reason, it’s useful to be mindful of the kind of contraception you want to use and you should have the opportunity to discuss birth control options with a healthcare professional in the days after giving birth. 

Exercises 

Pelvic floor exercises can help strengthen the muscles around the vagina and anus. They can also help healing by reducing the pressure on the cut and the surrounding tissue.

They are achieved by squeezing the muscles around your vagina and anus as though you are stopping yourself from going to the toilet.

Our mission at Natural Cycles

Thanks for taking some time to learn more about episiotomy and perineal tear. Here at Natural Cycles, we care about creating better awareness around women’s health. Natural Cycles is an app that can help you on your own personal fertility journey, whether your goal is to find a hormone-free birth control or to plan pregnancy. The app also makes it easy to log your symptoms so you can keep track of the changes that happen in your body throughout your cycle. 

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Written By

Jack Pearson

With 10 years of experience working in the field of fertility, Jack Pearson is Natural Cycles’ in-house expert. As Medical Affairs Manager, he dedicates his time to conducting groundbreaking research and educating healthcare professionals.