An episiotomy is an incision on the perineum to make the vaginal opening larger. It is performed in the final stage of labor when the baby is crowning. The incision is made with scissors or a scalpel under local anesthetic (unless the laboring parent already has a functioning epidural) and is sutured after the baby’s birth. Episiotomy cuts are made in the perineum, which is the tissue and muscle between the vaginal opening and anus.
The frequency of routine episiotomies in the U.S. has decreased dramatically in recent years. This is because research on the procedure shows that it is not effective at preventing perineal damage, creates higher rates of infection and pain, can lead to more severe additional tearing, and can cause more long term complications when compared with natural tearing. According to Leapfrog data from US hospitals, rates of episiotomy have dropped 63% and now hover at 4-5% of all vaginal births.
Can an episiotomy still be necessary?
The answer is maybe. ACOG suggests that an episiotomy can still be considered when a baby needs to be born very quickly, and in some other limited circumstances. As with any procedure, an episiotomy requires your consent.
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 natural tearing or a mediolateral incision. Still, mediolateral incisions can be more painful and can have worse long-term pain.
Recovering after an episiotomy or spontaneous tear
You’ll get sutures to repair the wound 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 for the first 24-48 hours, take ibuprofen or acetaminophen (stay away from aspirin while you’re breastfeeding), and do warm sitz baths after the initial few days.
Reduce irritation by changing your pad often and using a squirt bottle to wash off urine. Make sure to keep the area clean, and do not use donut-shaped pillows for sitting (as they create more swelling and slow down healing). 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 after giving birth.
Sometimes there are folks many years out from delivery who have been living with pain or incontinence 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 those with obstetric trauma. You deserve to feel like yourself and to live free from pain.
Reviewed by the Ovia Health Clinical Team
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Sources
- “What is an episiotomy?” ACOG. ACOG. October 2020. https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-is-an-episiotomy
- “State of Maternity Care in the U.S.: The Leapfrog Group 2023 Report on Trends in C-Sections, Early Elective Deliveries, and Episiotomies.” Leapfrog Group. 2023. https://www.leapfroggroup.org/sites/default/files/Files/2023%20Maternity%20Report_Final_0.pdf
