Episiotomy

A surgical incision made in the perineum to enlarge the vaginal opening during birth.

What is an Episiotomy?

An episiotomy is a surgical incision made in the perineum—the area of skin and muscle between the vaginal opening and the anus—during the final stages of labor.

Historically, episiotomies were routine. However, modern medical evidence has changed this practice, and they are now only performed when medically necessary.

Why is it Performed?

Today, doctors only recommend an episiotomy in specific 'at-risk' situations:

• Fetal Distress: If the baby's heart rate drops and they need to be delivered very quickly.
• Instrumental Delivery: To provide enough space for the use of forceps or a vacuum extractor.
• Large Baby: If the baby's shoulders are stuck (shoulder dystocia).
• Risk of Severe Tearing: If a large, jagged, uncontrolled tear seems imminent.

Recovery and Healing

If you have an episiotomy, the incision will be stitched closed immediately after the delivery of the placenta.

• Pain Management: Sitting on a 'donut' pillow, using ice packs, and taking warm sitz baths can help.
• Hygiene: Using a 'peri bottle' with warm water after using the restroom is essential to prevent infection.
• Stitches: Most episiotomy stitches are dissolvable and will disappear on their own within 10–14 days.

Can I Avoid One?

Yes! You can include your preference for avoiding an episiotomy in your birth plan. Techniques such as perineal massage (starting around week 34) and using warm compresses during the pushing stage can help the tissue stretch naturally and reduce the need for an incision.

The Bottom Line

While the idea of an incision is scary, an episiotomy is a tool used to ensure the safety of you and your baby during a difficult delivery. Open communication with your provider before labor is the best way to ensure your wishes are respected!