When Is an Episiotomy Needed?

Not too long ago, having an episiotomy during childbirth was almost expected. But, research over the last few decades shows the procedure may not be as beneficial as doctors once thought. Therefore, it is no longer as routine as it was years ago. However, an episiotomy is still helpful and necessary in certain circumstances. Here’s what you need to know about an episiotomy including when it’s recommended and when it’s not, how to try to prevent one, and what to do if you need it.  

What Is It? 

An episiotomy is a minor surgery during childbirth.

This cut is made during the second stage of labor right before the baby's head is delivered. After the baby is born, the doctor uses stitches to repair the incision.

How Common It Is

Before the eighteenth century, written information on prenatal care focuses on the protection and preservation of the perineum. The first description of an episiotomy dates back to 1742, and it made its way into a medical journal in 1810. Then, as childbirth started moving away from home deliveries with other women and midwives to hospital births with doctors, there were more and more episiotomies performed. From 1940 through 1980, the procedure was extremely common and a part of up to 80 percent of births.

After 1980, questions about the benefits of an episiotomy began to surface leading researchers to study it. Since the 1990s, when the studies started to show the procedure is not beneficial in uncomplicated births, its use has fallen steadily. And, by the year 2000, it was a part of approximately 33% of deliveries.

In 2012, it was down to about 12 percent.

When It Is Needed

An episiotomy is usually not needed in a healthy birth without any complications. Experts and health organizations such as ACOG and the World Health Organization (WHO) only recommend an episiotomy if it is medically necessary.  However, if you or your baby are in danger or you're having complications, the doctor may do an episiotomy to make the delivery safer for you and your child. 

An episiotomy is more likely if:  

• It is your first pregnancy.
• You are an older mom. 
• The baby is very big.
• The baby is breech or in another challenging birth position. 
• The baby is showing signs of distress.
• You have your labor induced. 
• You have an epidural. 
• The baby needs to be born quickly due to distress or a delivery complication such as cord compression.
• You are starting to tear in a place that may cause future health problems such as near your urethra.
• The doctor needs to use a vacuum or forceps.
• You've had previous perineal surgery or injury.

Complications of an Episiotomy

Episiotomies were so common for so long because doctors believed that they helped to prevent complications for mothers and babies. But, research shows that it might not be the case.

And, since an episiotomy is a surgery, it comes with its own set of risks and complications.

The complications of an episiotomy include:

• Tearing along with the incision
• Swelling filled with blood (hematoma)
• The edges of the cut not healing well
• Blood loss
• Infection
• Pain
• Urinary issues
• Fecal incontinence
• Painful intercourse
• The chance of tears in future deliveries

Prevention

You can't completely prevent an episiotomy, just like you can't completely prevent a c-section. But, there are some things you can do to reduce your chances of needing one.

• Choose a doctor who does not do them routinely.
• Talk to your doctor about your preference and your wish to not have one unless it's medically necessary.
• Promote healthy perineal tissue by eating nutritious foods and staying hydrated.
• Learn and practice Kegel exercises.
• Stay physically active with safe prenatal exercises.
• Use perineal massage.
• Learn and use other birth positions such as sitting upright instead of the traditional labor pose of lying down on your back.
• Have a birth attendant provide perineal support during labor and while you're pushing.
• Use warm compresses on the perineum during the pushing phase.
• Practice breathing exercises.
• Follow your healthcare providers instructions on when and how long to push.

If You Need One

You can talk to your doctor, prepare your body, and do everything right to try to prevent an episiotomy, but still, need one. Your doctor or midwife will try to respect your choice, but you and your baby's safety is their number one concern. There is just no way of knowing how the delivery will go until you're there. So, try to keep an open mind. And, remember, your doctor wants to do what's best for you and your child.

Caring for an Episiotomy

Your perineum may be swollen and painful after childbirth, especially if you had an episiotomy. The pain and discomfort may last for a week or two as your body begins to heal, but the full healing of your perineal area can take up to six weeks. To relieve discomfort and help your perineum and episiotomy heal more quickly after childbirth, you can:

• Wash your hands before and after caring for your perineum.
• Clean the area after using the bathroom with a spray bottle or peri bottle of warm water.
• Always clean from front to back to prevent contamination of your wound with germs from the rectum.
• Change your pad and clean the area after using the restroom and at least every four to six hours.
• Ask the doctor about a stool softener to help make bowel movements more comfortable.
• Learn how to work the sitz bath and use it.
• Place ice packs on the area or use maternity pads with built-in cold packs.
• Use witch hazel pads.
• Try a numbing cream, foam, or spray.
• Sit on a soft pillow or donut pillow.
• Continue your Kegel exercises.
• Get off of your feet and get enough rest.
• Talk to your doctor and take the recommended pain medicine if you need it. 
• Watch for the signs of infection and call the doctor if you are in too much pain, you notice an odor, or you develop a fever.

A Word From Verywell

As it is, most moms are worried about the pain of childbirth. Add to that the thought of an episiotomy, and it's no wonder it can sound so scary. But, by talking to your doctor and asking questions, you can learn more about the procedure. Then, you can be a part of the decision and better prepared for your experience in labor and delivery.

Of course, while many deliveries do not require an episiotomy, there are times when it's unavoidable. Hopefully, you won't need it, but if you do, you can get through it. After all, a safe and healthy delivery is what's most important.