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Episiotomy

(Perineum Incision; Incision, Perineum)

Pronounced: ip-eez-ee-AWT-o-me

by Julie Rackliffe Lucey, MS

Home | Health Information Center | Procedure & Surgery Fact Sheets | Article

Definition

Reasons for Procedure

Possible Complications

What to Expect

Call Your Doctor

En Español

Definition

The perineum is the area between the vagina and the anus. It is made up of skin and muscle. During an episiotomy, an incision is made in the perineum.

Reasons for Procedure

The incision is made to make the vaginal opening larger during birth. In the past, this incision was common. But it is no longer routinely done.

Your doctor may do an episiotomy if:

The baby is:
- Premature or otherwise fragile
- Large and the shoulders may be hard to deliver
Forceps or a vacuum are needed to assist in the delivery

Possible Complications

Some short-term complications may include:

Bleeding
Infection
Bruising
Swelling
Difficulty controlling your bowels

Factors that may increase the risk of complications include:

Severe scar tissue in the area
Prior problems with chronic pain in the vulva
Short perineum

What to Expect

Prior to Procedure

During a prenatal visit, talk to your doctor about the benefits and risks of an episiotomy.

Anesthesia

If you have not had epidural anesthesia during labor, the doctor may use local or regional anesthesia.

Description of the Procedure

The infant's head will start to stretch the vaginal opening. Special scissors will be used to make an incision in the perineum area.

There are 2 different incisions that may be used:

Midline incision: starts at the vagina and follows a straight line to the anus
Mediolateral: starts at the vagina and continues at an angle

Midline vs. Mediolateral Episiotomy

After delivery of the baby and placenta, your doctor will close the incision with absorbable stitches.

How Long Will It Take?

This is done during childbirth.

Will It Hurt?

If you receive anesthesia, you will not feel pain during the procedure. After delivery, most women have discomfort and swelling. You may need to take pain medication.

Average Hospital Stay

The usual length of stay for vaginal delivery is 2 days. An episiotomy will not extend your stay.

Postoperative Care

Your stitches will dissolve in about 10 days. The cut will heal within about 2 weeks. There may still be some soreness until the skin gets its natural strength back. This could take up to 6 weeks. During that time, you may find it uncomfortable to sit or walk.

While you recover:

When your doctor tells you to, do Kegel exercises. Simply squeeze the muscles you use to stop the flow of urine. This strengthens the pelvic floor muscles and can help the area heal faster.
Avoid having sex, douching, and using tampons for 6 weeks or as directed by your doctor.

Call Your Doctor

After arriving home, contact your doctor if any of the following occur:

Signs of infection, including fever and chills, swelling, redness, foul-smelling discharge
Pain that you cannot control with the medications you have been given
Bleeding from the episiotomy site
Continuing problems with loss of urinary or bowel control

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American College of Nurse-Midwives
http://www.midwife.org

American Congress of Obstetricians and Gynecologists
http://www.acog.org

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

Women's Health Matters
http://www.womenshealthmatters.ca

References:

Episiotomies. Brigham and Women's Hospital website. Available at:
...(Click grey area to select URL)
Accessed September 12, 2017.

Episiotomy. ACOG practice bulletin No. 71. Obstet Gynecol. 2006;107:957-962.

Episiotomy. American Pregnancy Association website. Available at:
...(Click grey area to select URL)
Updated August 2015. Accessed September 12, 2017.

Last reviewed September 2018 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG
Last Updated: 9/24/2014

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