shared decision making: during labor & delivery

Episiotomy

What is an Episiotomy?

An episiotomy is a surgical incision in the perineum -- the area between the vagina and the anus -- that is sometimes done during childbirth to allow enough room for the baby to be delivered.

At one time, episiotomies were routine because it was thought that surgical incisions heal better and cause fewer complications than vaginal tearing. Research has shown this is not true. In most cases, a vaginal tear, also known as a perineal laceration, is preferable to having an episiotomy.

Is There a Way to Prevent Vaginal Tearing?

There is no sure fire way to avoid vaginal tearing during childbirth. It is very common, although it is usually not severe, requires only a few stitches to repair, and heals in a few weeks. Sometimes more serious tearing does happen, which involves a more complicated surgical repair and takes a little longer to heal.

One thing that may help is called perineal massage. During the second stage of labor, when you’re pushing, your care team may use warm compresses or mineral oil to soften and stretch the perineum. In some cases, this can help avoid tearing.

When Are Episiotomies Recommended?

Episiotomies are not routine anymore but there are some situations where your care team may recommend it. These situations include:

●     If your care team thinks severe vaginal tearing may occur

●     If your baby is large

●     If your baby needs to be delivered immediately

Healing After an Episiotomy or Tear

After an episiotomy or tear, the area may feel sore for the first week or two but will heal and feel back to normal. If you had stitches, they will dissolve on their own. Ice packs, numbing spray, witch hazel, stool softeners and pain medications can all help with any discomfort you may feel.

Signs of Infection

The area should get a little better every day. If it gets worse instead of better, that may be a sign of infection. Other signs include the wound becomes hot or swollen or there is a pus-like discharge. Contact your care team right away if you have any of these symptoms.

Do I Have a Choice?

Your care team will only recommend an episiotomy if it is safer for you and your baby, and they will discuss it with you at the time of delivery. If you have any questions or concerns about episiotomies or tearing, make sure to talk with your care team.