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An episiotomy is a surgical procedure that enlarges the vaginal opening during labor by cutting the perineum, the skin and muscles between the vulva and anus.

Episiotomy is the surgery most commonly performed on women in the United States.

Between 50 and 90% of women giving birth to their first child undergo this procedure. For decades, episiotomies have been performed on a routine basis to help speed delivery during the second stage of labor; as well as to prevent tears to the mother's vagina, especially serious tears that may stretch to the anus. The procedure was also thought to lessen trauma to the baby and protect the mother's vaginal muscles.

Episiotomies May Be Useful Under The Following Conditions:

  • Labor is too fast. If you are unable to stop pushing and slow your labor, some health care providers believe a clean cut may help prevent a serious tear.
  • Fetal or maternal distress. An episiotomy may speed delivery if you or your baby are experiencing complications.
  • Extremely large or breech baby. An episiotomy may help ensure a safe delivery by widening the vaginal opening.

Currently, there is disagreement in the medical field about the routine performance of an episiotomy. One large study showed that routinely cutting an episiotomy increases the risk of tears in the back of the vagina, but reduces tears in the front. Based on these results, the World Health Organization, among other groups, recommends avoiding episiotomy unless it's absolutely necessary.

What Will Happen?

If an episiotomy is needed, then just before your baby is born, as the head is about to crown, your care health provider will inject a local anesthetic in the bottom of your vaginal opening and make an incision.

There are two types of incisions: median and medio-lateral. The median incision goes straight down the vagina toward the anus; the medio-lateral incision is made at an angle from the vagina to the anus. The medio-lateral is considered less likely to tear through to the anus, but is more difficult to repair and takes longer to heal than the median.

Your health care provider will then deliver the baby through the enlarged opening, followed by the placenta. The incision is stitched closed immediately after delivery.

For most women healing is uncomplicated, although it may take several weeks. You can help speed the process by asking nurses to apply ice packs immediately following the birth.

To Continue The Healing Process Over The Next Few Weeks You Should:

  • Use sitz bath a few times a day, change your pads frequently, and try a heat lamp or hair dryer after you bathe to keep the area around the stitches clean and dry.
  • Take stool softeners and eat lots of fiber to prevent constipation.
  • Perform Kegel exercises. Squeeze the muscles that you use to hold in urine for five minutes, 10 times a day, during your regular activities.


To Help Relieve Your Pain And Discomfort You Should:

  • Take a warm bath, but not before 24 hours postpartum.
  • Apply warm compresses, ice packs, or witch hazel to the affected area.
  • Take medications like ibuprofen, a non-steroidal anti-inflammatory, to help relieve pain.

Your stitches do not need to be removed since your body will absorb them. Normal activities, such as light office work or housecleaning, can be resumed within a week after giving birth. Tampon use, intercourse, or any activity that might rupture the stitches, can be resumed in about a six weeks. Talk to your health care provider if you have any concerns.


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