Episiotomy

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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 doctor 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
• a forceps or vacuum must be used to help in the birth
• monitors show that the baby is 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


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?

Most episiotomies are done to prevent large vaginal tears during childbirth. These tears heal slowly, often with poor results. Widening and tearing of the vagina may cause unneeded stretching. This may later lead to problems such as:
• urinary incontinence, which is being unable to hold urine in the bladder
• a prolapsed bladder, in which the bladder sags down into the wall of the vagina
• a prolapsed rectum, in which the rectum sags down into or through the vagina
An episiotomy may help to prevent these problems.

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 tub of warm water a few times a day. Wash the area gently with a stream of water after using the bathroom.
• relieve pain and swelling with Tucks pads and ice packs. Sitting on an inflatable donut helps, too.
• avoid constipation to keep this tender tissue from stretching too much. Take stool softeners, such as docusate, and drink 8 to 10 glasses of fluids each day.
• use over-the-counter pain relievers, such as acetaminophen or ibuprofen, as needed.
• avoid sexual intercourse for 6 weeks after the birth.
A woman should see her doctor 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 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

Author:Eva Martin, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:07/09/02
Reviewer:Kathleen A. MacNaughton, RN, BSN
Date Reviewed:10/28/02