Episiotomy

An episiotomy is a cut made to widen the opening of thevagina. It is done toward the end of labor to keep the vaginal tissues fromtearing as the baby is born. Sometimes an episiotomy can also help thedoctor 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 decideswhether 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 enoughoxygen 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 thevaginal 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 to3 inches long is made there. After the baby is born and the placenta isdelivered, the cut is stitched up.

What happens right after the procedure?

Most episiotomies are done to prevent large vaginal tearsduring 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 infectionand to helping speed healing. The stitches will dissolve after a period oftime 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. Washthe area gently with a stream of water after using the bathroom.

relieve pain and swelling with Tucks pads and ice packs. Sitting on aninflatable 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 acetaminophenor ibuprofen,as needed.

avoid sexual intercourse for 6 weeks after the birth.

A woman should see her doctor for follow-up visits to checkon 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 increasedrisks of this problem are:

infection

bruising

the forming of a hole between the vagina and rectum that is calleda fistula