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Episiotomy and Perineal Tears

Overview

An episiotomy (say "eh-pih-zee-AH-tuh-mee") is a cut the doctor or midwife makes in the perineum (say "pair-uh-NEE-um"), which is the area between the vagina and anus. It is 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. It is stitched up after the birth.

When is an episiotomy needed?

There are times when an episiotomy is needed—for example, if the baby's heart rate drops too much during pushing or if the baby's position is causing problems. The decision cannot be made until delivery. Episiotomies are more common with first-time deliveries.

Routine episiotomy is not recommended. Experts say that episiotomy:1

  • Usually is not needed, especially during routine births.
  • Does not tend to heal faster than a perineal tear. And it often causes more pain.
  • Can cause more damage to the muscles around the vagina and rectum than a tear does.

In the past, episiotomy was a very common part of childbirth. Many doctors no longer do episiotomies routinely. But a few still do. If you have a concern about this, talk to your doctor or midwife ahead of time.

Can you prevent perineal tears?

It's not uncommon for the perineum to tear during birth. But there are steps you can take to help prevent this:1, 2

  • Pay attention to your position during labor. Different positions may put less pressure on your perineum. You may feel more comfortable sitting upright, lying on your side, or getting down on your hands and knees, for example.
  • Talk to your birthing coach ahead of time so you agree on when and how hard you should push.
  • Have someone provide perineal support. This means pushing against the perineum to protect it from tearing as the baby's head stretches it. This is sometimes done with a hot, moist cloth.
  • Practice perineal massage. This type of massage makes the tissue around the vagina more flexible. Some studies show that women who massage this area daily during the last part of their pregnancy are less likely to have tearing.2

Recovery from an episiotomy or perineal tear

If you had an incision (episiotomy) or a tear in the area between your vagina and anus (perineum) during delivery, your doctor or nurse-midwife will repair it with stitches, using a local anesthetic. An ice pack will be placed against your perineum to ease pain and swelling.

Recovery from an episiotomy or tear can be uncomfortable or quite painful, depending on how deep and long the incision or tear is. Pain typically affects sitting, walking, urinating, and bowel movements for at least a week. Your first bowel movement may be quite painful. An episiotomy or tear is usually healed in about 4 to 6 weeks.

To reduce pain and promote healing:

  • Keep an ice pack on your perineal area.
  • Try an anesthetic spray.
  • Have regular sitz baths in a tub of warm, shallow water.
  • Take pain medicine. Some pain medicines can be constipating, so ask your health professional for a formulation that includes a stool softener.
  • Take stool softeners and drink lots of fluids to help soften stools and ease pain.
  • Use warm water from a squeeze bottle to keep the perineal area clean. Pat it dry with gauze or a sanitary wipe. Only wipe your perineal area from front to back.

Related Information

References

Citations

  1. Agency for Healthcare Research and Quality (2005). The Use of Episiotomy in Obstetrical Care: A Systematic Review. Evidence Report/Technology Assessment No. 112. Available online: http://www.ahrq.gov.
  2. Beckmann MM, Garrett AJ (2006). Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews (1).

Other Works Consulted

  • American College of Obstetricians and Gynecologists (2006, reaffirmed 2008). Episiotomy. ACOG Practice Bulletin No. 71. Obstetrics and Gynecology, 107(4): 957–962.
  • Kettle C, Tohill S (2008). Perineal care, search date April 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised November 2, 2011

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