Episiotomy and Perineal Tears

Overview

What is an episiotomy?

An episiotomy (say "eh-pih-zee-AH-tuh-mee") is a cut, or incision, made in the perineum during childbirth. The perineum is the tissue between the vagina and anus. The cut may be done to help deliver the baby or to help prevent the muscles and skin from tearing.

The cut is made just before the baby's head comes out of the birth canal. The cut is stitched up after the birth.

Why is an episiotomy done?

There are times when an episiotomy is needed. For example, it may be needed if the baby's heart rate drops too much during pushing. Or it may be done if the baby's position is causing problems. The decision can't be made until delivery.

Routine episiotomy is not recommended. Experts say that it's usually not needed during most births.^{footnote 1}

In the past, an episiotomy was a very common part of childbirth. Most doctors no longer do these cuts routinely. If you need an episiotomy, your doctor or midwife will tell you. It's a good idea to talk about an episiotomy during a regular prenatal visit.

What is a perineal tear?

It's common for the tissue between the vagina and anus (perineum) to tear during birth. This is called a perineal tear. The doctor or midwife usually closes the perineal tear with stitches. A small tear may be allowed to heal on its own without stitches.

There are some things you and your doctor or midwife might do to try to prevent a tear. For example, you may try doing perineal massage in the weeks before you go into labour. Or your provider might support your perineum with their hand or a warm cloth when your baby is being born.

What can you expect as you recover from an episiotomy or perineal tear?

After your baby is born, the doctor or midwife uses stitches to close the cut (episiotomy) or tear in the area between your vagina and anus (perineum). These stitches don't need to be removed. They will dissolve in 1 to 2 weeks or longer.

Recovery can be uncomfortable. The amount of pain you have depends on how deep and long the cut or tear is. You may have pain when you sit, walk, urinate, or have bowel movements. The pain may last for at least a week. Your first bowel movement may be quite painful. An episiotomy or tear usually heals in about 4 to 6 weeks.

To reduce pain and promote healing:

• Put ice or a cold pack on your perineal area.

  Do this for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.

• Try an anesthetic spray.
• Have regular sitz baths in a tub of warm, shallow water.
• Avoid constipation and straining.

  Drink plenty of water. Your doctor or midwife may recommend medicine to prevent constipation.

• Pour or spray warm water over your vagina and anus after you use the toilet.

  This will help keep the area clean. Pat it dry with gauze or a sanitary wipe. Only wipe your perineal area from front to back.

• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.