Episiotomy and perineal tearing risks and aftercare tips.
Babies heads are pretty big. When you give birth there’s a good chance your vagina will tear. Many tears are mild and heal up without any problems at all but around one third of women in the UK and US experience tears which are severe enough to need stitching.
The idea of having an episiotomy, where vaginal tissues are intentionally cut, may make your eyes water but there are situations when it is the best thing to do including the need to deliver baby quickly or preventing a larger, deeper spontaneous tear. Understanding why an episiotomy might be necessary and knowing how to look after your episiotomy after childbirth will mean you’re well prepared should you find yourself in this position.
To put your mind at ease Dr Juliet McGrattan explains everything you need to know about the procedure including episiotomy risks, aftercare and recovery tips:
What is an episiotomy?
The word episiotomy comes from the Ancient Greek words for pubic region (epísion) and cutting (tomia). An episiotomy is a planned cut of the perineum during the late stages of labour. The perineum is the area of skin between the vagina and the anus. Cutting this skin essentially makes the vagina bigger which then makes delivery of the baby easier.
When do you need to have an episiotomy?
Around 85 per cent of women have some form of damage to their vaginal wall during childbirth. This includes spontaneous tears and episiotomies. Most tears are minor, heal quickly and don’t have any long lasting effects for the mother. Sometimes tears are deep and severe and can lead to long term problems for the woman.
An intentional episiotomy, where tissues are carefully cut to allow widening of the exit for the baby is often felt to be better than letting a large tear happen naturally. Safe delivery of the baby is obviously paramount and sometimes the risks that an episiotomy may bring are smaller than the risk of harm to the baby with a delayed delivery.
You might need to have an episiotomy in the following situations:
- Your vaginal tissues aren’t stretching enough to deliver baby’s head and there’s a risk you will tear badly.
- Babyneeds to have an assisted delivery using a vacuum cup (ventouse) or forceps.
- Baby needs to be delivered quickly because it is in distress or the mother has a health condition such as a heart condition where a quick delivery is recommended.
- Baby is being born feet first (breech delivery).
Who needs an episiotomy?
An episiotomy is done in around 1 in 7 deliveries in the UK. Before labour it is impossible to say for certain who will need to have one. There are however certain women who are more at risk of requiring one:
- Women who are having their first baby
- Women with large or badly positioned babies
- Older women
- Women who have significant scar tissue from previous tears and episiotomies
How is an episiotomy carried out?
If an episiotomy needs to be performed, the midwife or doctor will discuss this with you and explain the reasons. They will only proceed with your agreement and consent.
The vaginal area will be cleaned and some local anaesthetic injected into the tissues that are going to be cut. Sterile scissors will be used to make a clean cut in the tissues from the back of the vagina, usually directed diagonally outwards.
After the baby has been delivered, the cut will be stitched up using sutures that gradually dissolve over the coming weeks. This will be done soon after you have given birth using local anaesthetic in the skin so you don’t experience any pain.
How to care for an episiotomy
It’s important to look after your episiotomy wound and prevent it from becoming infected. Follow these 8 episiotomy aftercare steps to minimise the risk of infection:
- Bathe at least once per day
Sit for a few minutes in a shallow bath. Plain water is fine. You can add a couple of drops of tea tree oil if you like. Pat the area dry with a clean towel.
- Wipe front to back
Always wipe from front to back after having a poo to keep bowel germs away from the wound.
- Use warm water
Pour warm water over your vulva after you have been to the toilet.
- Change your pads
Change your sanitary towel and underwear frequently.
- Wash your hands
Wash your hands before you touch the wound area and before changing pads.
- Look out for infection
Watch out for signs of infection such as a sticky discharge, increased pain, redness or an unpleasant odour.
- Avoid constipation
Avoid constipation by drinking plenty of fluid and eating lots of fresh fruit and vegetables.
- Air the stitches
Lie down for 10 minutes, a couple of times a day, without underwear, to let air get to the stitches.
How long will my episiotomy take to heal?
Most episiotomy wounds heal up fully within four weeks. The stitches can feel a bit sore for a few days but this will ease as the tissues become less swollen. If you are struggling with discomfort you can try the following things:
- Sit in a cool bath for a few minutes.
- Pour tepid water over your vulva while you pass urine if it is stinging.
- Hold an ice pack against the wound. Always wrap ice in fabric, never apply it directly to the skin.
- Lie down for a rest. Being on your feet for too long in the early stages can make the tissues swell and stitches pull.
- Take some simple pain killers such as paracetamol.
- Use a sanitary towel to press gently on the wound and support it while you open your bowels.
- Begin doing pelvic floor exercises as soon after birth as you can. Working the muscles around the vagina and anus will boost circulation in the area, help support the tissues and speed up healing.
How soon can I have sex after an episiotomy?
You can have sex as soon as you feel comfortable to do so. Every woman is different. Never feel any pressure to return to sex after childbirth, wait until you feel ready. Penetrative sex can be painful for a few months after an episiotomy. If you think this is because your vaginal tissues are dry, try using a lubricant. If pain is persisting or you have any other concerns, then speak to your doctor.
Don’t forget you can get pregnant quickly after giving birth, even before your first period starts. Speak to your midwife about contraception before you have sex.
What are the risks of an episiotomy?
Episiotomies are only done when medically necessary. The risks have to be balanced against the risks that arise from not doing one which may involve a delayed delivery causing distress and potential harm to the baby.
Some complications of an episiotomy might occur include:
- Infection of the episiotomy wound.
- Poor healing of the wound.
- Pain in the perineum.
- Painful sex.
- The episiotomy extending into a deep tear with risks of urinary and faecal incontinence and the psychological effects of these conditions.
How can you prevent an episiotomy?
There is some evidence that women who use techniques to stretch their perineum before they go into labour have a reduced chance of needing an episiotomy. Daily massage of the perineum and gentle stretching of the back of the vaginal opening during the last weeks of pregnancy can be beneficial. Read our perineal massage tips on how to minimise vaginal tearing.
During labour it’s important to listen and follow the instructions given by your midwife. For the head to be delivered slowly and allow the tissues to stretch, you may have to stop pushing and do some panting.
Just because you have had an episiotomy during one birth does not necessarily mean that you will need one during further deliveries. You are at a higher risk of requiring one because when the wound heals the scar tissue that forms can be less stretchy than normal tissues.