What Is Episiotomy? - Definition, Healing & Complications

Instructor: Marisela Duque

Marisela teaches nursing courses at the college level. She also works as a unit educator, teaching experienced nurses about changes in nursing practice.

After completing this lesson, you will be able to define episiotomy, describe the healing process, and list the complications associated with this procedure. A short quiz follows the lesson.

The Perfect Delivery

Every first-time mother-to-be dreams of her perfect birth experience. She will look like a goddess with glowing skin and sparkling beads of sweat on her brow. She will not need any pain medicine because the contractions will be easily managed with deep-breathing and focus exercises. Her labor coach will be strong and say the right thing at the right time. The baby will be born and look at her instantly with love and admiration for her hard work in laboring. The baby will then latch perfectly and breastfeed easily before lulling-off to a peaceful slumber in her arms.

Unfortunately, this perfect scenario is far from the usual reality of hospital-births and intrusive procedures, like I.V. fluids, labor-inducing medications, and cesarean deliveries. Although not ideal, there has been many an instance where being prepared and needing a medical procedure, such as an episiotomy, during delivery has saved the life of a mommy and her baby. Read on to learn more.

What's an Episiotomy?

An episiotomy is a medical procedure in which the healthcare provider widens the vaginal opening before the delivery of the baby. This is done by making an incision (cut) on the perineum (the space between the vagina and the anus). Although most women in labor will not need this procedure, it is sometimes necessary in emergencies. Cases that warrant an episiotomy include when the baby needs to be delivered quickly, if the baby is in an abnormal position, or if extensive vaginal tears are likely during the delivery.

There are two types of cuts made during an episiotomy. These are the median and the medio-lateral incisions. The median is the most common; this is a straight cut towards the anus, in the center of the perineum. The medio-lateral cut is made at an angle; it's less likely to tear through to the anus but takes longer to heal.

This image depicts both types of episiotomies: median and medio-lateral.

Episiotomies were once performed routinely. This is because it was once thought that it prevented mothers from having vaginal tears during the delivery. We now know that vaginal tears that occur naturally during the process of delivery heal better than artificial tears, like an episiotomy. Although this procedure may sound painful, most mothers do not feel anything. Many times the epidural medication that was given to help with painful contractions is enough to numb the perineum during the procedure. If no epidural was given, or if it wears off, then your doctor can inject a local anesthetic to the perineum that will provide adequate pain relief.

Possible Complications

Like with any medical procedure, there are some risks involved with having an episiotomy. These include having the cut become larger during the delivery (it may reach all the way down to the anus), increased blood loss, and infection. Furthermore, some women may find sex very painful for the first few months following childbirth.

The Healing Process

Many women say that the most difficult part of having an episiotomy is the healing process. While not extremely painful, the wound after an episiotomy can be quite uncomfortable as it heals. The tenderness in the perineum can make it uncomfortable to walk or sit for weeks following the delivery (ouch!).

Luckily, there are some relief measures that can help with the healing process. These include:

  • Ice on the perineum - helps with pain & swelling
  • Sit carefully - sit down slowly while tightening your buttocks and place a pillow under you for cushion
  • Sitz bath - a portable tub that you place on the toilet to let warm water cover the wound
  • Medication - there are many prescription and over-the-counter pain medications that can be prescribed by your doctor to make the pain more bearable
  • Complementary therapy - many women swear by witch hazel pads on the perineum or lavender oil; always ask your doctor before trying any complementary therapies

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