What Is an Epidural?

Childbirth is a powerful experience, but sometimes a little extra help is needed to make delivery smoother. An episiotomy—a small incision made in the perineum—might be recommended to assist with delivery. While it's not always necessary, understanding what an episiotomy is and why it might be performed, can help you feel more prepared. In this article, we'll break down the episiotomy meaning, why it may be needed, and what to expect during recovery—so you can approach childbirth with greater confidence.

What Is an Episiotomy?

An episiotomy is a surgical incision made in the perineum by your healthcare provider during labour to help widen the vaginal opening and assist with delivery. While this procedure was once a routine part of vaginal childbirth, it’s now performed less frequently.

In the past, healthcare providers believed that an episiotomy could prevent severe vaginal or perineal tears and promote faster healing compared to natural tearing. It was also thought to provide better support for the pelvic floor muscles. However, current research shows that episiotomy does not always prevent these issues or offer additional benefits, which is why it’s now used less often.

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If you’re hoping to avoid an episiotomy, consider discussing this with your healthcare provider beforehand. They can help you understand when and why an episiotomy might be necessary, ensuring you feel informed and prepared for labour.

Why Might I Need an Episiotomy?

During childbirth, the vaginal tissues gradually stretch to accommodate your baby. However, certain situations might require your little one to be delivered before the vagina has fully stretched. In these cases, an episiotomy may be performed to help prevent severe tearing and support a quicker, safer delivery. If you’re wondering what an episiotomy is and why it might be necessary, your healthcare provider can help you understand when this procedure is the safest option for both you and your little one.

Here are some situations where an episiotomy might be needed:

• Shoulder dystocia. This is when your baby’s shoulder is stuck behind your pelvic bone. 

• Your baby has an abnormal heart rate during delivery.

• Your baby requires an operative vaginal delivery. This is when either forceps or vacuum extraction (using a special suction cup) are used. An operative vaginal delivery may be done if you’ve been pushing for a long time without progressing as expected, or if you’re not able to push the baby out because of a medical condition or an issue with the baby.

Types of Episiotomy Incisions

Two main types of episiotomy incisions may be performed during childbirth:

• Midline (Median) episiotomy incision. This incision is made vertically, starting from the vaginal opening and extending straight down toward the anus. While this type of episiotomy is usually easier to repair, it does carry a higher risk of extending into the anus.

• Mediolateral episiotomy incision. This incision is made at an angle from the vaginal opening, down toward the left or right side of the anus. It’s often chosen to help prevent a tear from extending into the anus, but it tends to be more painful and may be more challenging to repair.

Natural Tear vs Episiotomy

During childbirth, a natural tear may occur as the baby passes through the vaginal opening. In contrast, an episiotomy is a deliberate incision made by your healthcare provider. Both options have their pros and cons, and the choice depends on the circumstances of your delivery.

A natural tear may happen gradually as the tissues stretch, and while it may not always tear in a controlled way, it often heals well on its own. Some studies suggest that natural tears may be less painful and heal faster than an episiotomy. However, severe tears may extend into the anus, potentially leading to complications.

An episiotomy, on the other hand, allows the healthcare provider to make a precise incision, potentially reducing the risk of an uncontrolled or severe tear. But, because an episiotomy is a surgical cut, it may involve a longer healing time and more discomfort compared to a natural tear.

Discuss your preferences with your healthcare provider, so they can guide you based on your specific delivery needs. Whether you experience a natural tear vs. episiotomy, your provider will help manage the situation for the safest outcome for you and your baby.

Healing Process of Episiotomy

Most episiotomy wounds heal within a few weeks, though more extensive incisions may take longer to fully recover. Understanding the different episiotomy healing stages may help manage expectations and ensure proper episiotomy care during recovery. Your healthcare provider might recommend over-the-counter pain relievers, prescription medication, or a stool softener to ease any discomfort.

While topical creams and ointments aren’t typically effective, there are several ways to care for an episiotomy and manage discomfort during the episiotomy healing time:

• Use a pillow or padded ring when sitting to reduce pressure on the area (check our hospital bag checklist for more helpful items).

• Run warm water over your perineum with a squeeze bottle (known as a “peri bottle,” which is usually provided to you by your healthcare provider) when urinating to ease stinging.

• Cool the area with an ice pack or apply a chilled witch hazel pad to reduce swelling.

• Sit in a shallow bath of warm or cool water, ensuring the affected area is submerged, for about five minutes to soothe discomfort.

• If needed, consult your healthcare provider about using a numbing spray or cream.

Proper care for an episiotomy may make the healing process smoother. If you notice signs of infection or the wound isn’t healing as expected, consult your healthcare provider for further guidance.

Complications of Episiotomy

While an episiotomy may be helpful in certain situations, it carries some complications, including:

• Severe tearing. The incision may extend beyond what was intended, leading to third- or fourth-degree tears that affect the anal sphincter or rectum.

• Infection. As with any surgical procedure, there is a risk of infection, which may cause additional pain and delay healing. 

• Painful intercourse. Some parents may experience discomfort during sex for months after the procedure.

• Pelvic floor issues. A severe tear may lead to problems like urinary incontinence or pelvic floor dysfunction. 

• Extended recovery. Healing times may be longer, and scarring may occur, especially with more extensive incisions.

These episiotomy complications can also occur with natural tears. Your healthcare provider will assess your specific case to determine the best course of action.

How long is the Episiotomy Healing Stage?

Episiotomy healing usually takes about a month, though recovery time can vary depending on the depth and length of the incision. Healing from a natural tear usually follows a similar timeline to that of an episiotomy.

During the first few weeks, it's common to experience pain, soreness, and sensitivity. Some discomfort during sex may also occur once your healthcare provider gives you the green light to resume intercourse. 

Be sure to communicate with your provider about your recovery progress and any discomfort you may feel. They can help assess whether your healing is progressing as expected, based on the type and severity of the episiotomy performed.

Episiotomy Infection Signs and Symptoms

It's important to keep an eye on the episiotomy healing stage and contact your healthcare provider right away if you experience any of the following symptoms, as they could indicate an infection or complications such as a separation of the repaired area:

• Severe pain or pain that gets worse over time.

• Pain that won’t go away. Despite following recommended care.

• Fever, which could signal an infection.

• Leaking urine or leaking stool, which may suggest issues with healing or a more severe tear.

These symptoms should be addressed immediately to prevent further complications and ensure proper recovery.

The Bottom Line

Childbirth doesn’t always go according to plan, and you might not have a strong preference about whether an episiotomy is needed. What matters most is understanding the procedure and trusting your healthcare provider to make the best decision for you and your baby when the time comes.

Whether you experience a natural tear or an episiotomy, your provider will guide you through the episiotomy healing process and help ensure a safe recovery after childbirth.

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_{How We Wrote This Article The information in this article is based on expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}