Will I need an episiotomy?

You may have heard that an episiotomy is a possibility with a vaginal birth—but what exactly is it? And is it necessary?

An episiotomy is a surgical cut during the pushing stage of labor between the vagina and rectum (the perineum) to enlarge the vaginal opening. It’s rarely necessary, which is why routine episiotomies—once common—are no longer recommended by the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization.

Episiotomies increase the risk of infection and blood loss; an incision could be more extensive than a natural tear. Natural tears typically heal better than incisions.

An episiotomy may be needed if your baby is in true fetal distress, such as if baby’s cord is compressed during birth.

How to avoid episiotomy

Follow your body’s instincts to push by pushing only when you have the urge to push. Your midwife or nurse may recommend performing perineal massage during pushing. Avoid birthing while lying on your back. Birth in an upright or side-sitting position and change positions frequently. Ask for a warm compress to be placed against your perineum during pushing.

What can I expect if I need an episiotomy?

Your doctor will make sure your perineum is numbed and make either a vertical (midline) or angled (mediolateral) incision. After baby’s birth, your provider will close the cut with stitches.

Recovery may take a few weeks. The incision may feel tender as you walk or sit. Keep your perineal area as clean and dry as possible; change sanitary pads every 2-4 hours. Pat yourself dry front to back to decrease infection risk. Recommended comfort measures include using:

• Ice packs
• Chilled witch hazel pads
• Warm water rinse bottle sprayed toward the incision during or after urination
• Sitz bath: soak your perineum in warm water with either Epsom salt or tea bags
• Stool softeners to prevent constipation

Can I refuse an episiotomy?

Ask your healthcare provider if or when they would do an episiotomy and include your thoughts about episiotomy in your birth plan.

In 2012, 12% of vaginal births involved episiotomy—that’s down from 33% in 2000.

Watch for these complications

Tell your healthcare provider if you experience any of the following after episiotomy:

• Fever
• Painful sexual intercourse
• Infection
• Swelling
• Bleeding from the incision
• Leaking gas or stool if you have cut rectal tissue
• Pus-like discharge
• If the incision opens