Episiotomy

What is Episiotomy

Episiotomy is an incision that is made in the area of skin between the vaginal opening and the anus (perineum). An episiotomy helps to make the opening of the vagina larger to allow more room for the baby to fit through during childbirth.

An episiotomy may be done when your health care provider determines that it is necessary in order to safely deliver your baby. Usually, it is done:

• To help prevent complex tears in the vagina, vulva, perineum, and rectum.
• If your baby’s head or shoulders are too large to fit well through the vaginal opening.
• If your baby needs to be delivered quickly.

Typically, an episiotomy is done at the very end of a delivery and just before the baby is born.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with the use of anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• More tearing of your perineum as your baby comes out of the birth canal.
• A collection of blood (hematoma) in the episiotomy area.
• Loss of bowel control.
• Poor healing, resulting in bulky scar tissue.
• Pain or difficulty with sex.

What happens before the procedure?

• Discuss your birth plan with your health care provider:
  • Ask any questions you may have about this procedure.
  • Talk about your concerns and understand when an episiotomy may be necessary.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• You may be asked to sign a consent form before your baby’s birth. This form will ask you to agree to have the procedure done if it becomes necessary.

What happens during the procedure?

• Your perineum area will be cleaned.
• A medicine to numb the area (local anesthetic) may be injected into your perineum. If you were given an epidural (epidural anesthetic), the local anesthetic may not be needed.
• An incision will be made in one of the following locations:
  • Straight down between the vaginal opening and the anus (midline incision).
  • Downward from the vaginal opening and directed away (angled) from the rectum (mediolateral incision). This type of incision is done so the muscles around the anus (anal sphincter) do not tear.
• After your baby is born and the placenta has been delivered, the episiotomy will be closed with dissolvable stitches (sutures).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You will be given medicine to help relieve pain, if needed.
• Ice may be placed on the episiotomy area. This helps to numb the area and reduce swelling.
• Your health care provider may recommend that you take frequent baths in water that is deep enough to cover your hips and buttocks (sitz baths) to keep the perineal skin clean.

Episiotomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain or aching around the episiotomy area.
• Redness and mild swelling around the episiotomy area.
• A tugging or pulling sensation at the episiotomy area because of the stitches.

Follow these instructions at home:

Managing pain, swelling, and discomfort

• On the first day after your episiotomy, put ice on the episiotomy area if directed by your health care provider:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Bathe using a sitz bath as directed by your health care provider. A sitz bath is a warm water bath that is taken while you are sitting down in water that is deep enough to cover your hips and buttocks. Take sitz baths as often as your health care provider recommends to help relieve pain, itching, or swelling.
• If told by your health care provider, apply a numbing spray to the episiotomy area to help relieve discomfort.
• Wear sanitary pads for as long as told by your health care provider. Use pads that contain witch hazel. Witch hazel can help relieve discomfort and swelling.
• If sitting down is uncomfortable, try sitting on an inflatable ring or pillow.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• If you were prescribed an antibiotic medicine, use it as told by your health care provider.Do notstop using the antibiotic even if you start to feel better.

Activity

• Ask your health care provider what activities are safe for you.
• Do nothave sex or use tampons for at least 6 weeks, or until your health care provider says it is safe.
• Do notlift anything that is heavier than 10 lb (4.5 kg) or the limit that your health care provider tells you until he or she says that it is safe.
• Do notswim or use a hot tub until your health care provider approves.

General instructions

• Follow instructions from your health care provider about how to take care of your episiotomy area. Make sure you:
  • Wash your hands with soap and water before and after you apply medicine to the area. If soap and water are not available, use hand sanitizer.
  • Keep the area around the stitches clean and dry. After bathing, pat the area gently with a clean, dry towel.  Do notrub it.
• Check your episiotomy area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not scrub the area between the vagina and the anus (perineum).This could cause pain or irritation or open any stitches you may have.
• After using the bathroom, use a squeeze bottle (peri-bottle)to clean your genital area. To do this:
  • From front to back, squeeze warm water on your perineum, then pat the area dry.
  • Instead of wiping after using the bathroom, use the peri-bottle instead for as long as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain is not relieved with medicines.
• You have painful urination.
• You do not have a bowel movement for 4 or more days.
• You pass a blood clot that is larger than a walnut.
• You have more fluid or blood coming from the episiotomy area.
• Your episiotomy area is warm to the touch.
• You have a fever.

Get help right away if:

• You have more redness or increasing pain in the episiotomy area.
• You have pus coming from the episiotomy area.
• You notice a bad smell coming from the episiotomy area.
• Your episiotomy opens.
• You notice swelling in the episiotomy area that is larger than when you left the hospital.
• You cannot urinate.