episiotomy is a surgical cut made just before delivery in the muscular area between the vagina and anus (the area called the perineum) to widen the vaginal opening.
Obstetricians use routine episiotomy to hasten delivery and prevent vaginal rupture, especially at first birth.
Many experts believe that a clean incision such as an episiotomy will heal much easier than a spontaneous rupture. But a lot of big studies done over the last 20 years have denied this theory and most experts believe that this procedure should not be done routinely.
Researchers have shown that women who suffer from spontaneous rupture recover at the same time or even faster and often with fewer complications than episiotomy wounds.
Women who undergo an episiotomy are at risk of losing more blood during delivery, experiencing greater pain during recovery, and have to wait longer before having sex without problems.
Moreover, women who do an episiotomy are more likely to have severe ruptures of the anal sphincter or even the rectal wall (known as grade 3, respectively grade 4 lacerations) than women who are born without being cut. These severe ruptures result in more pain in the perineal area after birth, and require a significantly longer recovery period and are more likely to affect the contraction power of the pelvic muscles. Wounds that break the anal sphincter increase the risk of anal incontinence - problems in controlling the emission of faeces and gases.
Why is an episiotomy required?
In a few cases, an episiotomy may be necessary for your or your child's well-being:
How can I be sure that I will not make an unnecessary episiotomy
Talk to your doctor in advance about your feelings about this procedure. Ask him how and under what conditions such an intervention will do and how he can help you avoid this cut. Also, ask about other colleagues, in case you happen to be born assisted by someone else. Studies show that midwives, as a group, do far fewer episiotomies than obstetricians.
You may opt for perineal massage starting about 6 weeks before giving birth. Few studies show that perineal massage may reduce the risk of rupture or the need for an episiotomy.
How is the episiotomy done?
If your doctor decides to do an episiotomy, he will give you an injection with a local anesthetic and use surgical scissors to make a small cut in your perineum. Sometimes, if your perineum is already numb and subdued by the pressure exerted on the child's head, the doctor will be able to do your episiotomy without using pain medication.
This is sometimes called pressure episiotomy. Otherwise, you will receive a new dose of local anesthesia to make sure you are completely numb before your doctor sews the cut.
Recovery after episiotomy
If you have had an episiotomy or a rupture, you will have stitches in a very sensitive area and you will need time to heal. Your seams will be resorbed during the weeks after delivery and will not need to be removed.
Some women will experience mild pain for a week or two, others will have a discomfort for a month or more, especially if they have a third or fourth grade laceration. Use ice packs on the perineal area immediately after birth and intermittently for the next 12 hours to numb the area and prevent or reduce swelling. For an extra tip on how to take care of yourself, read our article on postpartum perineal pain.
When can I start having sex again?
Your perineum should be completely healed in about six weeks after birth, so your GP will give you the OK and you will be able to try having sex again. Initially you might feel sensitivity and redness (limiting the movements of a joint). Try to drink a glass of wine, take a warm bath and give enough time to the prelude. You may prefer to sit on top so that you have control over the degree of penetration, or you may find it more comfortable to sit on one side.
Relax as much as possible and use a good water soluble lubricant, and these will help you have more comfortable sex. These will be helpful especially if you are breastfeeding, as lactation lowers estrogen levels and thus reduces the amount of lubricant the vagina produces. Many women continue to use a lubricant during intercourse until they finish breastfeeding.
Tags Episiotomy Birth Birth Recovery