As a gynecologist, I often hear a common concern from expectant mothers preparing for vaginal delivery: “Will I need an episiotomy?” It’s a natural worry, and understandably so. The idea of a surgical incision during childbirth can be daunting.
Our Promise to You
As your healthcare provider, my priority is always your safety and the well-being of your baby. We will always discuss any necessary interventions with you. While an episiotomy might sound scary, remember that it’s a tool we use judiciously and only when truly needed to ensure the safest possible outcome for your delivery.
We are here to support you every step of the way, from understanding the procedure to managing pain and ensuring a smooth recovery. Don’t hesitate to ask any questions you have. We want you to feel empowered and informed throughout your birthing journey.
It’s completely normal to have questions about episiotomy, especially as you prepare for childbirth. Many expectant mothers share the same concerns. To help you feel more informed and less anxious, here are answers to the most frequently asked questions about episiotomy.
What Exactly IS an Episiotomy?
An episiotomy is a controlled, surgical cut made by your doctor in the tissue between your vagina and anus (after injecting a local anaesthetic) just before your baby is born. The goal is to widen the vaginal opening, creating more space for the baby to pass through.
A natural tear, on the other hand, happens spontaneously as your baby stretches the vaginal tissues during birth. While many natural tears are small and heal easily, some can be more extensive and jagged. An episiotomy is sometimes performed to create a cleaner incision that is often easier to repair and may heal more predictably than an uncontrolled, severe tear.
Why Might an Episiotomy Be Needed?
In modern obstetrics, episiotomies are not routinely performed. We always aim for a natural, tear-free delivery if possible. However, there are specific situations where an episiotomy becomes a necessary tool to ensure the safety of both mother and baby. These include:
- Controlled Incision: Sometimes, during the pushing phase, it becomes evident that the perineum is at high risk of a severe, jagged tear or injury to the anus or urethra (which can be more difficult to heal). A controlled incision can be a safer alternative in such a case. Unlike a spontaneous tear, an episiotomy is a clean, surgical cut. This often results in a tear that is easier to repair and may heal more predictably.
- Faster Delivery in Emergencies: In situations of fetal distress, an episiotomy can significantly speed up the delivery process, which can be crucial for your baby’s well-being.
- Assisted Delivery: When instruments like forceps or a vacuum extractor are needed to help deliver the baby, an episiotomy can provide the necessary space and prevent more extensive, uncontrolled tears.
- Large Baby: In some cases, if your baby is particularly large, an episiotomy might be considered to facilitate delivery and prevent significant tearing.
- Prolonged Pushing: Sometimes, if the pushing stage of labor is very long and progress is stalled, an episiotomy might be done to help speed things up.
It’s important to understand that your doctor will discuss this with you at the moment if time permits, explaining the need for the procedure.
What About the Pain After Delivery?
Let’s be honest: you will likely experience some pain and discomfort after an episiotomy. This is normal, just like with any surgical incision. The area will be numb from the local anesthetic or epidural for a while. You’ll likely feel soreness, stinging, and pressure for some days. Sitting can be uncomfortable. The initial pain and soreness usually subside within 2 weeks after delivery. Most episiotomy wounds heal completely within 3 to 4 weeks. The stitches used are dissolvable and will absorb on their own, so they don’t need to be removed.
Need more information or support on this topic? Dr. Daksha Bakre can help you.
Tips for Healing and a Smoother Recovery
While recovery takes time, there’s a lot you can do to promote healing and ease discomfort:
- Keep it Clean: Gently wash the area with warm water after every visit to the toilet. Pat dry with a clean, soft cloth – don’t rub.
- Ice Packs: Applying ice packs (wrapped in a cloth) to the perineum for 15-20 minutes at a time, several times a day, can significantly reduce swelling and pain, especially in the first 24-48 hours.
- Sitz Baths: Soaking in a shallow, warm bath (Sitz bath) for 15-20 minutes a few times a day can be incredibly soothing and promote healing.
- Pain Relief Medication: Take your prescribed pain relievers as directed. Don’t try to tough it out!
- Sitting position: While sitting cross-legged is a familiar and comfortable position for many, it’s generally not recommended in the immediate postpartum period, especially after an episiotomy. Use a donut-shaped cushion or a soft pillow when sitting to reduce pressure on the stitches.
- Avoid Straining: To prevent strain on your stitches, try to avoid constipation. Drink plenty of water and eat fiber-rich foods. Your doctor might recommend a stool softener.
- Rest: Listen to your body and rest as much as possible. Avoid heavy lifting and strenuous activities.
- Pelvic Floor Exercises (Kegels): The general advice is that you can often start gentle Kegel exercises as soon as you feel comfortable, usually within the first few days after delivery. Gentle Kegel exercises can improve blood flow to the area, which is crucial for faster and more efficient wound healing.
- Wear Breathable Underwear: Choose loose-fitting, cotton underwear to allow air circulation and prevent moisture buildup.
- Choose the Right Type of Pad: In the first few days, you will have heavy bleeding, and regular sanitary pads won’t be sufficient. You’ll need large, absorbent maternity pads, which are designed for this heavy flow and are usually softer and thicker than standard pads. Look for pads with a soft, cottony surface. Many disposable pads today have a “dry-weave” or plastic-like top layer that can be irritating or cause sweating, which is not ideal for a healing wound. 100% cotton-top layer pads are highly recommended. Opt for unscented, undyed pads to minimize the risk of irritation or allergic reactions to the sensitive healing skin. Change your pad at least every 2 to 4 hours, even if it doesn’t seem full, especially in the initial days. If your flow is heavier, change it more often. Tampons or menstrual cups are strictly contraindicated in the postpartum period because they can introduce bacteria into your still-healing uterus and vagina, leading to serious infections. Pads are the only safe way to manage postpartum bleeding. Using pads allows you to easily monitor the amount, color, and consistency of your vaginal bleeding, which is an important indicator of your healing progress.
- Watch for Signs of Infection: Keep an eye out for increased pain, redness, swelling, pus, or fever. If you notice any of these, contact your doctor immediately.
- Nutrition: Beyond the local care, what you eat plays a huge part in how quickly and smoothly your episiotomy heals. Your body has been through a tremendous event, and providing it with the right nutrients is like giving it the best building blocks for repair. Focus on whole, unprocessed foods rich in protein, iron, fiber, vitamin C, and minerals. Stay well-hydrated. The biggest takeaway is to prevent constipation, as it can be the most challenging aspect of episiotomy recovery.
When should I contact my doctor about my episiotomy wound?
A: It’s important to monitor your healing and contact your doctor if you experience any of the following:
- Increasing pain that isn’t relieved by medication.
- Redness, excessive swelling, or warmth around the incision.
- Foul-smelling discharge or pus from the wound.
- Fever or chills.
- The wound opening up (stitches coming undone).
- Difficulty controlling bowel movements or gas (though some temporary changes can be normal).
- Any other concerns that worry you.
Frequently Asked Questions.
No, episiotomy is performed when there’s a specific medical reason to do so, for the safety of both mother and baby.
No, you won’t feel the pain of the incision as it is performed under local anesthesia.
While there’s no guaranteed way to prevent an episiotomy (as medical necessity can arise unexpectedly), some practices might help reduce the risk of extensive tearing or the need for an episiotomy:
- Perineal massage: Starting around 34-36 weeks of pregnancy, gently massaging the perineum can help improve its elasticity. Discuss this with your doctor.
- Pelvic floor (Kegel) exercises: Strengthening these muscles throughout pregnancy can contribute to better tissue elasticity.
- Controlled pushing: Listening to your body and your care team’s guidance for slow, controlled pushing can allow tissues more time to stretch.
- Warm compresses: Applying warm compresses to the perineum during labor can help relax the tissues.
Not necessarily. The need for an episiotomy is assessed at the time of each birth based on your specific circumstances and your baby’s condition. Many women who have had an episiotomy in a previous birth go on to have a vaginal birth without one the next time.
It’s common to experience some discomfort or pain during sex in the first few months after childbirth, regardless of whether you had an episiotomy or a natural tear. Using a water-based lubricant and communicating openly with your partner can help. We recommend waiting for 8-10 weeks after child birth for initiating sexual activity.
For many, the Indian-style toilet (squat toilet) is a part of daily life. However, after an episiotomy, the squatting position can be challenging and potentially uncomfortable or even risky during the initial healing phase. It’s generally recommended to wait until your stitches have completely healed and you are pain-free before attempting to use an Indian-style toilet. This usually means waiting at least 4-6 weeks postpartum, and often longer, depending on your individual healing process and comfort level. If you have access to a Western-style commode, it is highly recommended to use it for the first 4-6 weeks after delivery. If Indian-Style Toilet is the ONLY option then try to avoid a deep squat. You might use a stool or small chair to sit on over the Indian toilet, raising your height and reducing the depth of the squat. There are even specialized commode chairs designed to be placed over Indian toilets. Lean on a wall or hold onto a grab bar if available to support your balance when getting down and up.
It’s generally NOT recommended to apply anything other than recommended antiseptic creams directly to fresh episiotomy stitches for the first 2-3 weeks due to a risk of Infection.Once the stitches have dissolved or are mostly absorbed, the wound has closed, and there are no signs of active infection or discharge (typically after 2-3 weeks, or around your 6-week postpartum check-up, with your doctor’s approval), coconut oil may be considered for scar massage and softening.
The general recommendation is to wait for 3 months. Confirm that your postpartum bleeding has stopped. Even if your lochia has stopped before 6 weeks, do NOT use tampons or menstrual cups immediately. Your vagina might feel looser or different. You might need to try different sizes or brands of tampons or cups to find what’s comfortable. Your first few periods after birth (which might not occur for many months, especially if breastfeeding) can be different – heavier, lighter, or irregular.
References and further reading
https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/episiotomy
https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282
https://my.clevelandclinic.org/health/treatments/22904-episiotomy
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/episiotomy
https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/episiotomy-and-perineal-tears/
https://www.mountsinai.org/health-library/special-topic/episiotomy
Need more information or support on this topic? Dr. Daksha Bakre can help you.
Disclaimer
This article provides general information and is not a substitute for professional medical advice. Always consult your doctor to discuss your individual circumstances and the best course of action for you.