An Introduction to Episiotomy
An episiotomy is a surgical cut made in the perineum and the back wall of the vagina during birth, to widen the opening so the baby can pass. It's usually repaired with stitches under local anesthesia and takes about three to five weeks to recover, with most fully settled by six weeks. Many parts of the world now use episiotomies less often, reserving them for when they're clinically needed.
What is an episiotomy?
An episiotomy is a surgical incision in the perineal area and the posterior wall of the vagina. It's mainly performed to enlarge the opening so the baby can pass, and to limit more significant soft-tissue damage in the birth canal (including the anal sphincter and rectum). Its use is being reduced in many parts of the world unless clinically needed. Common reasons include:
- A higher risk of deep tears in the perineum, anal sphincter, or urethra (for example, during rapid labor)
- The need to shorten the second stage of labor
- Perineal muscle weakness
- A large baby
- Perineal edema (swelling)
- The need for an instrumental delivery (vacuum or forceps)
- Fetal bradycardia (a slow fetal heart rate)
How is an episiotomy performed?
An episiotomy may be done centrally or laterally using a scalpel or scissors. The type depends on the experience of the doctor or midwife and the anatomy of the woman's perineum. After birth, the site is sutured under local anesthesia. The stitches are either removed before discharge or absorbed by the body within weeks.
How do you care for an episiotomy and stitches?
Recovery from an episiotomy is usually straightforward. For the first days, nurses will care for the wound. To support recovery and lower the risk of infection, follow these guidelines:
- Rinse the vulva and perineum after each urination and bowel movement. A peri-bottle makes this easy.
- Pat the area dry and lie on a disposable absorbent pad.
- Change pads every three to four hours to discourage bacteria.
- Apply ice over a cloth (a bottle of frozen water works) for 10 to 15 minutes several times a day.
- Avoid stress on the wound: don't sit on hard surfaces or lift heavy things, and keep up good hygiene.
- After the sutures are out, take a soothing warm bath.
- Eat plenty of high-fiber plant foods to help digestion.
How long does an episiotomy take to recover?
On average, an episiotomy wound takes about three to five weeks, and is usually fully settled within six weeks. If you feel discomfort or irritation, or notice discharge from the wound, see your provider to check everything is OK.
Why might you want to avoid an episiotomy?
There are a few possible complications to be aware of. The main ones are postpartum pain, incontinence, and changes in sexual function. Some studies suggest the procedure itself can contribute to these. Other possible complications include:
- Infection, as with any surgical procedure
- Swelling and itching of the perineum or around the incision
- Bleeding during recovery, with small cracks at the incision site
- Damage to muscles or nerve endings of the perineum, usually resolving with rest, though sometimes a physiotherapist's input is needed
- Painful sensations when moving, bending, or sitting, which can last several months or longer
- Painful intercourse
How can you lower your chances of an episiotomy?
You can improve your chances of avoiding an episiotomy, especially when you and your baby are healthy and the baby is a normal weight and head circumference. Pelvic strengthening with Kegel exercises, staying active during pregnancy, good breathing, effective pushing, and a positive mindset are all helpful measures. Another option is perineal massage in the weeks before birth, which helps increase the elasticity of the perineal muscles so they can stretch more during labor. This is examined in research in relation to episiotomy. Perineal massage during labor is also discussed by many organizations, including the World Health Organization. If your provider supports it, add your favorite perineal massage oil to your maternity checklist.
Read The Ultimate Guide to Perineal Massage.
Frequently asked questions
What is an episiotomy?
A surgical cut to the perineum and back wall of the vagina, made during birth to widen the opening for the baby.
Why is an episiotomy done?
To help the baby pass more easily, often during a rapid labor, an instrumental delivery, or when the baby's heart rate needs labor shortened.
How long does an episiotomy take to recover?
About three to five weeks, usually fully settled by six weeks. Stitches dissolve or are removed before discharge.
How do I care for an episiotomy at home?
Rinse with a peri-bottle, pat dry, change pads often, apply ice, avoid pressure on the wound, and eat plenty of fiber.
Can you avoid an episiotomy?
Not always, but pelvic-floor exercises, staying active, good breathing and pushing, and perineal massage are among the measures discussed.
Additional resources
- NHS. Episiotomy. nhs.uk
- American Pregnancy Association. Episiotomy. americanpregnancy.org
