Episiotomy: Medical providers and mothers reassess the procedure

Are episiotomies a case of the cure being worse than the disease? It's a question that vexes many women and their health care providers. An episiotomy is the surgical incision in the perineum, the area between the vagina and the anus, that a doctor or midwife may make to widen the birth canal and ease the baby out.

For a long time episiotomies were simply a routine part of childbirth. The thinking was that a surgical incision would ease the delivery and avoid possible tearing and jagged lacerations that might otherwise happen, and that this procedure would prevent later urinary incontinence or a prolapsed (dropped) uterus.

Although there are differing opinions on whether or not episiotomies are necessary as a matter of course, there are times when a baby is in distress and must be delivered quickly. An episiotomy may be necessary in this circumstance.

Weighing the pros and cons

Some physicians perform episiotomies as a matter of course. Talk to your doctor about it and weigh the pros and cons of the procedure. Let your doctor or midwife know your preferences and ask how you can deliver your baby without one. Your practitioner may perform massage to help stretch the perineum. You can learn breathing exercises to keep yourself from pushing prematurely and causing tissue to tear.

The benefits of an episiotomy are that it may result in an easier and better repair than a jagged tear. It may also shorten the second stage of labor.

The risks may include:

Increased deep tearing
Increased blood loss
Poor healing or infection of the incision
Pain after delivery
Pain when having sex
Discomfort in the scar

If you have an episiotomy, be forewarned that you will probably have pain and soreness as the cut heals. There are some things you can do to feel better.

Warm soaks in a sitz bath or tub 24 hours after the incision. Get a doughnut-shaped air pillow to sit on; you'll feel much better.
Walking and doing Kegel exercises can help the healing process.
Apply cotton pads soaked in witch hazel.
Use a numbing spray available from your health care provider.
Lie down as much as possible. Sitting and standing increase swelling.

What about sex?

Your bottom needs to be healed before you resume having sex. This will take four to six weeks after giving birth. Talk to your provider to be sure it is okay. You may want to use a lubricant during sex.

Date last reviewed: October 2002.

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