An episiotomy is a surgical procedure where a small incision is made in the area between your vagina and anus (perineum) during childbirth. It's not as widely used as it once was, but there are some instances where your obstetrician performs an episiotomy.
Episiotomy is a procedure in which your obstetrician makes a small cut between the bottom of your vaginal opening and anus (an area called the perineum) during childbirth. An episiotomy makes the opening of your vagina wider, which allows your baby to come through more easily. Sometimes your perineum will tear naturally as your baby comes out. This is called perineal tear (or laceration).
Healthcare providers don't recommend routine episiotomies and prefer that you tear naturally. However, the procedure is still used in certain cases.
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While episiotomies are uncommon, there are still instances when your healthcare provider feels it's the safest option. These instances include:
The latest research suggests it's better to let the perineum tear naturally.
Healthcare providers once thought making a surgical incision would help the vagina stretch and prevent severe tears. Some also believed it could prevent complications like urinary incontinence and pelvic floor dysfunction. Your pelvic floor consists of muscles and tissue that support your uterus and help prevent urinary and bowel dysfunction. But newer research has shown episiotomies may not prevent complications and may make tears extend farther than intended.
An episiotomy is performed during a vaginal delivery. The specific process may vary depending on your obstetrician and your condition.
Generally, an episiotomy follows this process:
There are two main types of incisions:
Like perineal tears, healthcare providers describe the levels (or degrees) of episiotomy in relation to how severe the tear is. The degrees of an episiotomy are:
You shouldn't feel anything during an episiotomy. Your obstetrician uses a local anesthetic (typically injected into the area) to numb your perineal area so you don't feel pain. In some cases, you've already had an epidural and can't feel anything from your waist down. You can expect some pain and soreness once the anesthesia wears off.
In certain situations, an episiotomy helps reduce the risk of a bad natural tear. If you have an episiotomy, it's because it was the safest for you or your baby.
Complications that can occur due to an episiotomy include:
It’s important to note that the complications listed above can also occur with a natural tear.
Since episiotomies aren't routine, your healthcare provider will likely not recommend one unless it's necessary. Talk to your provider ahead of time and share your concerns about the procedure and your desire to avoid it.
It's hard to prevent perineal tears or an episiotomy since a lot of it is out of your control. Some healthcare providers recommend stretching your perineum during pregnancy to help prevent tearing. Massaging your perineal tissue (area between the vaginal opening and anus) in the weeks leading up to delivery may reduce the chances of tearing or needing an episiotomy. The research is mixed and providers aren't entirely sure stretching the perineum works, but it's usually harmless.
Another technique to reduce tearing is to apply a warm compress to your perineum during the second stage of labor. This may help make the tissue more flexible. Talk to your provider about perineal massage or other techniques to avoid tearing during childbirth.
Healing takes about one month, but this can vary depending on the degree of episiotomy. Natural tears usually require the same recovery time.
It's common to feel pain and soreness for the first few weeks and have some discomfort with sex (once you're given the OK for intercourse). Let your provider know how you're recovering and what your pain level has been. They can tell you if it's normal based on the type and severity of episiotomy you had.
The perineal area will be sore and painful for a few weeks after an episiotomy. Some things you can do at home to relieve your discomfort are:
Talk to your midwife or obstetrician about what you can expect and what activities you should avoid during the recovery period. Don't use tampons, have sex or insert anything into your vagina until your provider says it's OK.
Pain during sex after an episiotomy is common for several months. It might be helpful to use a water-based lubricant during sex to make it more comfortable. Your perineum should be healed by about six weeks postpartum, but you should wait until you've been examined and given the OK for sex at your postpartum visit.
If you've had an episiotomy, call your obstetrician if:
In 2006, the American College of Obstetricians and Gynecologists (ACOG) issued a recommendation against routine episiotomy. Studies found that an episiotomy doesn't prevent severe lacerations and may cause worse tearing. Additionally, it doesn't prevent complications like urinary or bowel incontinence or painful sex any better than a natural perineal tear.
A note from Cleveland Clinic
Needing an episiotomy is not as common as it once was. It involves your provider making an incision near your vaginal opening to allow more room for your baby to come out. When it’s done, it’s because it’s the safest way to deliver your baby. Talk with your healthcare provider about your chances of needing an episiotomy at one of your prenatal visits. They can help you understand the circumstances where one may be needed for your baby's health.
Last reviewed by a Cleveland Clinic medical professional on 05/03/2022.
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