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Episiotomy: what is it?

An episiotomy is an incision on the perineum to prevent severe tearing during delivery. It is performed in the final stage of labor right before the birth. The incision is made with scissors or a scalpel under local anaesthetic, unless one already has a functioning epidural, and is sutured after delivery. Episiotomy cuts are made in the perineum, which is the area between the vaginal opening and anus. 

The frequency of routine episiotomies in deliveries has decreased from 65% to 20% in the last 25 years as more evidence indicates that the procedure is not as beneficial as previously thought.

When is an episiotomy necessary?

An episiotomy may be used when delivering a large baby or to accelerate the delivery of a baby that has a concerning heart rate.

Types of episiotomies

There are two types of episiotomy incisions: a midline incision and a mediolateral incision. A midline incision is done in a straight line, from the vaginal opening toward the anus, whereas a mediolateral incision is done at an angle from the vaginal opening. There are pros and cons to each type. A midline incision is less painful, but tearing of the anus is more likely than it is with a mediolateral incision. Still, mediolateral incisions can be more painful and can have worse long-term pain. 

Drawbacks of episiotomies

According to recent research, those who undergo episiotomies bleed more in the final stage of labor and have longer, more painful recoveries than those who have spontaneous tears. Additionally, it increases the risk of infection and prolongs the time until comfortable intercourse. An episiotomy can even increase the chance of serious tears through the anus during delivery and the chance of damage to the pelvic floor muscles.

Recovering after an episiotomy or spontaneous tear

You’ll get sutures to repair the tear that will dissolve after several weeks. Most people don’t experience pain beyond the first week after delivery, but more severe tears can cause discomfort for a longer period of time. To cope with the pain, you can apply ice packs, take ibuprofen or acetaminophen (stay away from aspirin while you’re breastfeeding), and do sitz baths. 

Reduce irritation by changing your sanitary pad often and using a squirt bottle to wash off urine. Make sure to keep the area clean, and try not to sit for long periods of time. Don’t forget your handy-dandy kegels to improve pelvic floor muscle tone once you can perform them without feeling pain. 

Healing is different for everyone and takes at least six weeks. If you are experiencing persistent pain with intercourse or if you’re still feeling pain after six weeks from birth, it’s time to seek treatment. You do not need to live with pain, there are many options for treatment  

Sometimes we see women many years out from delivery who have been living with pain because they did not know that there were options for treatment and trained healthcare providers who specialize in obstetric trauma, like obstetricians and urogynecologists. There are also designated postpartum clinics to treat women with obstetric trauma. You deserve to feel like yourself and to live free from pain. 

This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic. 

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