An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening.
Obstetricians used to do episiotomies routinely to speed delivery and to prevent the vagina from tearing, particularly during a first vaginal delivery, in the belief that the “clean” incision of an episiotomy would heal more easily than a spontaneous tear. Many experts also believed that an episiotomy might help prevent later complications, such as incontinence.
But many studies over the past 20 years have shown that this is not the case. In fact, there is no good evidence that episiotomy offers your vaginal tissue and pelvic floor muscles any real protection, and the procedure may actually cause problems.
»Why might I need an episiotomy?
There are a few situations in which an episiotomy might be helpful.
If your baby is very large and your practitioner needs a little extra room to manipulate him during delivery or to apply forceps, she may opt to do an episiotomy. And if your baby needs to be born as quickly as possible – because his heart rate shows he isn’t handling the last minutes of labor well – your practitioner may decide that an episiotomy will help expedite the delivery. In these scenarios, an episiotomy may be essential to ensure your baby is delivered safely.
»How can I make sure I won’t have an unnecessary episiotomy?
Talk to your practitioner early on about the procedure.
Ask how often and under what conditions he would perform an episiotomy, and how he might help you avoid tearing. (Also ask about others in the practice, in case you end up with someone else at your delivery.) Studies show that, as a group, midwives tend to do far fewer episiotomies than obstetricians.
»How is an episiotomy done?
If your practitioner decides to do an episiotomy, she’ll give you an injection of a local anesthetic and use surgical scissors to make a small cut in your perineum shortly before the birth of your baby. (Sometimes, if your perineum is already numb and thinned out from the pressure of your baby’s head – or if you already have an epidural – she can do the episiotomy without pain medication.)
After you’ve given birth, you’ll get another shot of local anesthesia to be sure you’re completely numb before the cut is stitched up.
»What’s the recovery like?
If you’ve had an episiotomy (or a tear), you’ll have stitches in a very tender area, and you’ll need some time to heal. Your stitches won’t have to be removed – they’ll dissolve on their own during the weeks after delivery.
Some women feel little pain after the first week, while others have discomfort for a month or more, particularly if they have a third- or fourth-degree laceration.
»In the meantime, you can help promote healing:
*Soothe the wound. Apply an ice pack to the affected area, or place a chilled witch hazel pad between a sanitary napkin and the wound. You can find witch hazel pads in most pharmacies.
*Take the sting out of urination. Use a plastic cup to pour warm water over your vulva as you’re urinating, and rinse yourself with a squirt bottle afterward.
*Prevent pain and stretching during bowel movements. Press a clean pad firmly against the wound when you bear down for a bowel movement.
*Sit down carefully. Tighten your buttocks as you lower yourself to a seated position. Sit on a pillow or padded ring rather than a hard surface.
*Use medication as needed. Your health care provider might order prescription medications or recommend an over-the-counter pain reliever or stool softener. Pain-relieving creams or ointments haven’t been found to be effective for episiotomy wounds.
*Consider complementary treatments. Some research suggests that lavender might help relieve pain after a tear or episiotomy. If your health care provider approves, add a few drops of lavender essential oil to your bath water or apply the oil directly to the tissue between your vaginal opening and your anus.
While you’re healing, expect the discomfort to progressively improve. Contact your health care provider if the pain intensifies, you develop a fever or the wound produces a pus-like discharge. These could be signs of an infection.
»When can I have sex again?
Your perineum should be completely healed by four to six weeks after delivery, so if your caregiver gives the okay and you’re up to it, you can try having sex then. If you had a third- or fourth-degree laceration, it’s particularly important to wait to have sex until after you’ve been examined.
You might feel some initial tenderness and tightness. Try taking a warm bath and leaving plenty of time for foreplay. You might prefer to be on top so that you can control the degree of penetration, or you may find that lying on your side is most comfortable.
Relaxing as much as possible and using a good water-soluble lubricant will help make sex more comfortable. This may be especially helpful if you’re breastfeeding, because lactation lowers your estrogen levels, which reduces the amount of lubrication your vagina can produce. Many women continue to use a lubricant during sex until they stop nursing.
If you try these measures and find that sex is still uncomfortable or painful, talk to your caregiver about treatment.