Pregnancy Information Childbirth Episiotomy

A pregnant woman’s vagina may tear or rupture due to the strain of labor and delivery. To prevent vaginal lacerations and ease delivery, an episiotomy is sometimes performed.

What is an Episiotomy?

An episiotomy is a surgical cut made in a pregnant woman’s perineum (the area between the anus and the vagina) during labor. The episiotomy minimizes the chance of spontaneous vaginal tearing during labor, and may facilitate delivery. After delivery, the episiotomy incision is stitched closed with sutures that dissolve as the episiotomy heals.

Types of Episiotomy

A woman in labor requiring an episiotomy has two choices: a midline episiotomy or a mediolateral line episiotomy. A midline episiotomy is cut straight down towards the anus. A mediolateral episiotomy is cut at an angle.

Medical authorities are divided on which type of episiotomy is best. Proponents of the midline episiotomy argue that the incision is less painful, and heals faster after pregnancy. Supporters of the mediolateral line episiotomy note that an offline incision has less chance of spreading into, or even damaging, the anal sphincter.

If a midline episiotomy does damage the anal sphincter, the pregnant woman may experience bowel control difficulties. In a worst-case scenario, fecal incontinence results. A mediolateral line episiotomy takes longer to heal, but is less likely to affect the mother adversely after pregnancy.

As a pregnant woman does not know whether she will require an episiotomy for labor and delivery, she should discuss episiotomy options with her doctor before the pregnancy comes to term.

Episiotomy Use

EpisiotomyDoctors long thought that an episiotomy was the best way to control vaginal tearing in pregnant women during pregnancy and delivery and for many years episiotomy incisions were an almost routine part of giving birth.

Recent studies have challenged this long-held belief, indicating that most spontaneous vaginal tearing during labor and delivery is less painful than episiotomy incisions during recovery. Other studies note that most vaginal tearing during labor is no worse than the episiotomy itself.

With this in mind, the use of an episiotomy for pregnant women has come under evaluation. Today, an episiotomy is used only if absolutely necessary to facilitate labor and delivery and to avoid complications. An episiotomy may be used if the fetal shoulders enter the birth canal in a position that makes delivery difficult.

Recovering from an Episiotomy

If delivery requires an episiotomy, care must be taken in the days following delivery to prevent infection or tearing of the episiotomy stitches. Proper hygiene is essential; the site must be kept as clean as possible.

Constipation causes straining that can tear the episiotomy stitches and widen the incision (causing possible damage to the anal sphincter). A properly balanced, high fiber diet helps prevent constipation. Some physicians will recommend a stool softener during the few days following delivery.

Pain and discomfort from the episiotomy incision site may be relieved with painkillers. Warm baths may provide relief after the incision begins to heal. Consult with your doctor for the best pain management strategies, especially if you’re breastfeeding as some medications can pass to the infant through mother’s milk.

Resources

American College of Obstetricians and Gynecologists. (2003). Private practice physicians perform episiotomy at higher rate than residents and hospital faculty.

Beers, M.H.