What Is an Episiotomy?

An episiotomy is a surgical procedure that widens the opening of the vagina with a small incision at the bottom of the vaginal opening toward the anus. Once a routine practice during childbirth, today, healthcare providers typically only perform an episiotomy when necessary to safely deliver your baby.

Overview

What Is an Episiotomy?

An episiotomy is a surgical incision that can be done to widen your vaginal opening during childbirth. During this procedure, your doctor makes a small, straight (midline) or angled (mediolateral) incision in the perineum, the tissue between your vaginal opening and anus.

If you’re delivering your baby without an epidural or if the anesthesia from the epidural has worn off, your doctor will inject a local anesthetic into your perineum before making the incision. After you deliver your baby, your doctor will stitch the incision closed.

Why Is an Episiotomy Done?

In the past, doctors commonly performed episiotomies during childbirth to prevent large vaginal tears and preserve the integrity of the pelvic floor connective tissue and muscles.

However, current research shows that routine episiotomies don’t prevent severe perineal trauma and may lead to unnecessary complications like pain, infection, and incontinence (inability to control when you urinate or have a bowel movement). It’s now thought that an episiotomy may cause worse perineal tearing than a natural tear alone.


Today, healthcare providers only recommend and perform episiotomies in certain situations that may benefit you or your baby, such as:

  • Your baby is showing signs of distress, such as higher or lower fetal heart rate than normal or less fetal movement than expected, and the episiotomy will help speed up delivery.
  • Your baby has shoulder dystocia (when the baby's shoulders are stuck behind your pelvic bones).
  • Your doctor needs to use instruments like a vacuum or forceps to deliver your baby.

How Is an Episiotomy Performed?

If your doctor determines that an episiotomy is necessary to support the vaginal delivery of your baby, they should take the following steps:

  • Explain the procedure and obtain your consent.
  • Ensure pain control with anesthesia, either through an epidural or an injection of local anesthesia to your perineum.
  • Make an incision (midline or mediolateral) in your perineum with episiotomy scissors or a scalpel when your baby’s head is crowning, or pushing against your vaginal opening.
  • Repair the tissues and muscles of the perineum after delivery by closing the incision with absorbable stitches.

Your doctor will consider a few factors to decide on the type of incision to best support the delivery of your baby.

How Do I Prepare for an Episiotomy if Needed?

You won’t know for certain if you’ll need an episiotomy until you’re about to deliver your baby.

Some research suggests certain interventions may reduce the likelihood of a natural tear or the need for an episiotomy. These interventions include:

  • Perineal massage during pregnancy or in the second stage of labor
  • Application of warm compresses to the perineum while pushing

Talk with your doctor to learn more about these interventions and any concerns you may have about tearing or episiotomy use.

What Should I Expect During an Episiotomy?

During vaginal delivery, if it’s determined an episiotomy may be necessary, your doctor will perform the incision in the delivery room while you are on the hospital bed. The labor and delivery team will support your feet and legs so your doctor or midwife can clearly see your perineum to monitor your labor progress and perform the procedure.

Your doctor will make the episiotomy incision quickly, but the procedure won’t be complete until after you deliver your baby and placenta, when your doctor stitches the incision closed. Delivery length varies from one childbirth experience to another, so it may take some time before the procedure is considered complete.

What Are the Potential Risks Associated With an Episiotomy?

An episiotomy may come with potential risks, including:

  • Infection
  • Large tears from the incision that may extend through the anus and rectum
  • Bleeding and perineal hematoma, a collection of blood in the perineal tissues
  • Painful sex
  • Pelvic floor dysfunction
  • Scarring
  • Prolonged recovery time
  • Urinary or bowel incontinence

What Type of Care Is Needed Following an Episiotomy?

It’s normal to experience perineal pain and discomfort for two to three weeks following an episiotomy. Pain may be worse with walking, sitting, or urinating, but should improve over time.

To help reduce episiotomy incision pain, you can:

  • Use over-the-counter (OTC) pain relievers, such as acetaminophen or ibuprofen.
  • Apply a local anesthetic spray to your perineum to help relieve pain and itching.
  • Soak in a warm sitz bath —?either with a special tub that goes over the toilet or by sitting in a regular tub filled with little water.
  • Apply an ice pack or perineal cold pad (a combination ice pack and absorbent pad).
  • Sit on a donut pillow to take the pressure off your perineal area.

Over-the-counter stool softeners, drinking plenty of water, and eating a high fiber diet can also help prevent constipation and potentially painful bowel movements that can otherwise irritate the healing incision.

Keep your perineum clean and dry to promote wound healing and avoid an infection. Use a spray bottle (commonly called a “peri” bottle) of warm water on your perineal area when using the bathroom. This can help ease pain while you urinate and keep the incision site clean. Avoid using toilet paper, which can leave behind residue. Pat dry with clean gauze instead.

Don’t engage in activities that might rupture your stitches, including heavy lifting, using tampons, and having sex. Your doctor will give you the ok for these activities, typically around six weeks when the perineum is fully healed and your stitches have dissolved.

What Are the Possible Complications and Side Effects of an Episiotomy?

It's possible to develop an infection following an episiotomy. Call your doctor if you have these signs of infection:

  • Worsening perineal pain
  • Pus or unusual drainage from the incision site
  • Swelling or redness around the healing incision
  • Bleeding at the incision site
  • Fever, chills, or body aches

Some people develop excessive scar tissue after an episiotomy, which may itch or cause discomfort during sex or other activities.

Pelvic floor dysfunction can also occur after an episiotomy, and may cause painful sex or incontinence.

Painful sex is common for several months after an episiotomy. Discomfort is often worse following more severe episiotomies (third- or fourth-degree) that extend through the anal sphincter.

Extensive damage to the connective tissues and muscles of the pelvic floor may also result in urinary or bowel incontinence.

What’s Next

After your episiotomy has healed, if you experience any symptoms of pelvic floor dysfunction such as painful sex or incontinence, talk to your doctor. They may recommend specific exercises to support pelvic floor health. Or, your doctor may refer you to a pelvic floor physical therapist who can expertly address pelvic, bladder, and bowel pain and dysfunction.

Having an episiotomy doesn’t automatically mean you’ll need one again for future deliveries. Each labor and delivery experience is unique. Your doctor will determine whether you might need an episiotomy with your next baby at the time of delivery.

The Takeaway

  • An episiotomy is a surgical incision that’s made from the bottom of the vagina toward the anus to widen the vaginal opening during childbirth to help deliver a baby.
  • To avoid complications like infection, perineal trauma, pelvic floor dysfunction, and prolonged recovery time, healthcare providers only perform an episiotomy when necessary to promote a safe delivery.
  • Talk to your doctor about episiotomy risks, steps you can take to potentially avoid this type of incision, and how to optimize healing after the procedure if you have one.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Episiotomy. Cleveland Clinic. May 3, 2022.
  2. Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin. American College of Obstetricians and Gynecologists. June 22, 2016.
  3. Jiang H et al. Selective Versus Routine Use of Episiotomy for Vaginal Birth. Cochrane Database of Systematic Reviews. February 8, 2017.
  4. Barjon K et al. Episiotomy. StatPearls. July 24, 2023.
  5. Advancing Care For Childbirth-Related Pelvic Floor Disorders. Mayo Clinic. May 30, 2024.
  6. Wallace S et al. Pelvic Floor Physical Therapy in the Treatment of Pelvic Floor Dysfunction in Women. Current Opinion in Obstetrics and Gynecology. December 2019.
John-Paul-McHugh-bio

John Paul McHugh, MD

Medical Reviewer

John Paul McHugh, MD, is an obstetrician-gynecologist and lifestyle medicine specialist in southern California.?He has always placed wellness at the center of his work, in both delivering babies and improving practice standards. Dr. McHugh believes that bringing lifestyle medicine to the center of health and wellness empowers patients to make the change they seek and enjoy the benefits of true wellness.

He is a graduate of Harvard Medical School and the Massachusetts Institute of Technology and a fellow of the American College of Lifestyle Medicine. He served as a department chair at Scripps Mercy Hospital in San Diego and is now the chair-elect for the American College of Obstetricians and Gynecologists for California.

He has published several articles in the American Journal of Lifestyle Medicine and served as a peer reviewer for many articles. He contributed to the first textbook of lifestyle medicine in women's health: Improving Women's Health Across the Lifespan.

Angela McPhillips

Angela McPhillips, DNP

Author

Angela McPhillips is a registered nurse and doctor of nursing practice with over 15 years of healthcare experience. She earned her nursing degrees from the University of Illinois Chicago (UIC). Her postgraduate and doctoral specialty is advanced population health nursing, specifically meeting the needs of medically complex children and students with disabilities in school and community settings.

Angela’s clinical background includes pediatric emergency nursing, school nursing, and child welfare nurse consulting. Angela’s academic career includes six years of teaching a variety of nursing courses at UIC. As a freelance health writer, she excels at writing simple, easy-to-understand information that helps patients and consumers navigate their healthcare journeys and make well-informed decisions.

A native Chicagoan and recent Florida transplant, Angela enjoys spending time in nature exploring the beaches of southwest Florida with her husband and two young children.

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