You probably know enough about episiotomies, an incision that enlarges the vaginal opening so your infant can emerge during a vaginal birth, to know that you'd prefer to avoid a snip down there, thank you very much. The good news? These days, episiotomies are no longer the norm. In fact, midwives and most doctors rarely perform the procedure without good reason.
Until just a few years ago, practitioners routinely made the cut under the assumption that episiotomies protected women from spontaneous tears that were more difficult to heal and could lead to future problems like urinary incontinence. Doctors also feared that newborns faced birth trauma from the head pushing for too long against the perineum during labor.
However, recent research has debunked these theories, showing that both moms and newborns fare as well if not better without a standard episiotomy, and the American College of Obstetricians and Gynecologists (ACOG) now no longer recommends that episiotomies be performed routinely.
Still, this doesn’t mean that all women can avoid this procedure at every birth. Here’s more about episiotomies, including how common they are today and when they may be necessary, plus how to help them heal and steps you can take to avoid one in the first place.
What is an episiotomy?
An episiotomy is a minor surgical cut in your perineum (the muscular area between your vagina and anus). These cuts are made right before a vaginal delivery to enlarge the opening for your baby's exit.
How common are episiotomies?
Since the policy of routine episiotomies changed in 2006, the procedure’s rate has declined significantly. For example, in 2000, 33 percent of vaginal births involved an episiotomy, but just 12 percent did in 2012, the most recent year with data available.
Still, whether you have this cut or not may depend on where you get your medical care, as some episiotomy rates are as low as 1 percent and others as high as 40 percent.
Read This Next
When is an episiotomy procedure considered necessary?
While episiotomies are not recommended as often as they once were, there’s still a place for them in some birth scenarios:
- Big head. A larger noggin may need a roomier exit, so an episiotomy may be performed in these situations.
- Forceps or vacuum delivery. These tools may also need more space to maneuver.
- Complications. These can include a breech presentation (feet or bottom first) or shoulder dystocia, which means the shoulder is stuck in the birth canal.
- Preterm baby. An episiotomy may also be advised if your baby is preterm.
- Fetal distress. When the fetal monitoring of your baby's heart rate shows he’s in distress and not getting enough oxygen, this cut may be made so he can be born right away.
What happens during an episiotomy?
If it looks like you’ll need an episiotomy, you’ll be injected with a local anesthetic to numb the perineal area — though if you’ve already had an epidural you won’t need this extra bit of drug.
Next, during the second or pushing stage of labor, either scissors or a scalpel is used to make a median (also called midline) incision (a cut made directly back toward the rectum) or, more commonly in the U.S., a mediolateral incision, which slants away from the rectum.
After the delivery of your baby and the placenta, your practitioner will stitch up the cut (you'll get a shot of local pain medication if you didn't receive one before or if your epidural has worn off).
Episiotomy vs. natural tears: What’s better?
In the past, episiotomies were performed to prevent spontaneous tearing of the perineum and to reduce the risk of fetal birth trauma. But studies have shown that both infants and mothers generally fare just fine without one. In fact, when comparing those who have an episiotomy to ones who didn’t, the women who were allowed to tear spontaneously during labor:
- Recover in the same (or less) time and with less pain
- Have fewer complications, such as fecal and urinary incontinence, infection and blood loss
- Are less likely to have tears turn into more serious third- or fourth-degree lacerations
- Experience less perineal pain and experience faster healing
Are there risks associated with episiotomies?
Yes, as with any type of surgical procedure, there are some risks, such as a deeper wound than a natural tear would produce, possible infection and pain, including painful sex in the months post-birth. And a midline episiotomy may up the risk of a fourth-degree vaginal tear, which is one that goes close to or through the rectum, sometimes causing fecal incontinence.
How long does it take for an episiotomy to heal?
Everyone who delivers vaginally (and some moms who had a C-section) can experience some perineal pain after birth, which, unfortunately, is likely to be compounded if the perineum was surgically cut. Like any new wound, the site of an episiotomy will take time to heal, usually seven to 10 days. While you're in the hospital, a nurse will check your perineum at least once daily to be certain there's no inflammation or sign of infection.
How should you care for an episiotomy?
Keep in mind that the stitches you received won’t need to be removed — they’ll be absorbed by your body. You should also take it easy for a few weeks and wait for the green light when it comes to having sex and starting to exercise again.
To help prevent infection, your health care provider will instruct you in postpartum perineal hygiene, which includes the following:
- Ice packs. Cold compresses or ice wrapped in a washcloth or plastic bag can ease swelling and decrease pain.
- Sitz baths. Sit in shallow, warm water a few times a day to speed healing.
- Pain relief. Ask your doctor about over-the-counter medications like ibuprofen or a numbing application such as a spray or cream.
- Squirt clean. Use a small plastic water bottle to spritz your perineum during and after urinating and then gently pat the area dry with a soft towel or baby wipe.
Is there anything you can do to avoid an episiotomy?
Keep in mind that, occasionally, episiotomies turn out to be necessary and the final decision should be made in the delivery room. Still, it may be possible to reduce your risk. Here’s what you can try:
- Discuss the topic. Talk to your practitioner about your desire to avoid an episiotomy, if that's how you feel; it's very likely she’ll agree that the procedure can be skipped unless there's a good reason.
- Write it down. Note your wish to not have an episiotomy in your birth plan.
- Do Kegels. These exercises improve muscle tone and stimulate circulation.
- Massage the perineum. Help stretch this area with massage six weeks before your due date.
- Use warmth. When applied to your perineum during labor, warm compresses can soften the skin, enabling it to stretch more easily.
- Go slow. Push for only five to seven seconds at a time and bear down gently (instead of pushing hard for 10 seconds while holding your breath).
- Add counterpressure. Your practitioner can gently push back on your perineum as the baby's head emerges so that he doesn’t come out too quickly and cause an unnecessary tear.
Yes 
No 
Trending On What to Expect
