Episiotomy: What is It and How Does It Help Baby Delivery?

An episiotomy, or a perineotomy, is a surgical procedure in which an incision is made in the perineum. The perineum is the tissue located between the anus and vaginal opening of a woman. This procedure was previously a routine procedure during child birth. Nowadays, this is no longer the case. 

In case you are going to have a vaginal delivery (also known as a normal spontaneous delivery), you should know a few things about childbirth and episiotomy.

What is episiotomy for?

You might be required to undergo an episiotomy procedure in case your baby develops a medical condition known as fetal distress. In this medical condition, your baby’s heart rate may get faster or slower than the normal speed while the baby is in your womb. This may be caused due to lack of oxygen for the baby and consequently requires immediate delivery to prevent risks of stillbirth or birth defects.

Another reason to perform this surgery is the need to widen your vagina. Hence, instruments like ventouse suction or forceps are used to aid the birth process.

An episiotomy might be mandatory if:

• You are tired and unable to give birth even after pushing hard for many hours.
• Your baby might not come out with head first, which means you are having a breech birth.
• If you have health issues like heart diseases, you might be required to do the delivery as soon as possible to reduce any more health risks to yourself as well as the baby.
• Studies have shown that in certain births, especially the ones with forceps, an episiotomy might prevent tears (third-degree) that affect the anal muscle.

Risks

Some of the common complications and risks involved in this process are:

• Swelling
• Infection
• Bleeding
• Accumulation of blood in the perineal tissues
• Experiencing pain during sex
• Tearing into the rectal tissues and anal sphincter muscle. This muscle is responsible for controlling the passage of stool.

Depending on your health status, the risks may vary. Make sure you discuss all your health issues and overall health condition with your doctor or surgeon before your delivery process. 

How to prepare for episiotomy

Some preparations involved for this surgery are:

• Your doctor will explain the episiotomy process to you.
• You are required to inform your doctor about all your allergies or sensitivity to any medicine, treatment, etc.

Process

When you have a normal vaginal delivery, your doctor may perform an episiotomy. The type of episiotomy and its process depends on your medical condition.

Typically, this process looks like this:

• As a part of the surgery, you will have to lie on a delivery bed. Your legs and feet would be supported (lithotomy) for giving birth.
• You will receive a local anaesthesia injection into your perineal skin and muscle in order to numb the tissues before making the incision. In case an epidural anaesthesia is given, you won’t feel anything from your waist down. With epidural anaesthesia, you wouldn’t need more anaesthesia for the episiotomy surgery.
• At the second stage which involves pushing the baby out, your baby’s head will stretch your vaginal opening. This is when your surgeon will use scalpel or surgical scissors to make the episiotomy incision.
• Your doctor or surgeon will deliver the baby followed by the placenta.
• After the delivery, the doctor will check the incision in case any more tearing has occurred. 
• The surgeon then stitches together the perineal tissues and muscle, and these stitches dissolve on their own over a period of time.

Recovery period

The healing time for this surgery is approximately 4-6 weeks. The actual recovery duration depends on the incision size and what kind of suture (stitch) material is used to cover or close the wound.

Post-surgical care for episiotomy

As soon as this surgery is completed, the recovery care begins. The recovery phase should take into consideration both local wound care and pain management.

In the first 12 hours of the delivery, an ice pack might be extremely helpful in preventing pain and swelling of the wound site. The spot of incision and its surrounding area needs to be kept clean and dry. This helps prevent infection.

Spare 20 minutes 3-4 times a day and soak the wound part in a small tub or bucket (whichever is comfortable) filled with warm water. It is an easy and effective way to keep the wound area clean. After every bowel movement or urination, the episiotomy incision or wound area should be cleaned thoroughly. Probably, you can use a spray bottle with lukewarm water.

Sometimes you might feel some pain when urine comes in contact with the incision area. A spray bottle can be used to reduce that pain. After spraying with water or after soaking, the wound spot should also be dried properly and gently – either with the help of a tissue or very soft towel.

Ibuprofen or acetaminophen might be used to manage pain.

You should refrain from using tampons or douches in the post-delivery phase to enable smooth healing and to prevent re-injury of the same area. Do not have sex until your episiotomy is completed healed and confirmed upon by your doctor. This might take up 4-6 weeks after your delivery.

Key takeaway

An episiotomy is a surgical procedure in which an incision is made in the perineum as part of giving birth. It might be necessary to help facilitate successful delivery of the baby. Recovery time is about 4-6 weeks, during which the incision area must be cared for and kept clean.

Learn more about Labor and Delivery here.