Episiotomy

Definition
Episiotomy is a surgical procedure that involves cutting the perineum (skin between the vagina and the anus) during labor to enlarge the vaginal opening. The procedure is intended to prevent vaginal tears during delivery.

Description

Episiotomies were once routinely performed in an attempt to prevent tearing during labor, particularly to avoid tears that reach to the anus. The number of episiotomies performed remains high in the U.S., but there is now a great deal of controversy over whether they should be routine. Recent studies have shown that women who do not have an episiotomy might have a small tear, which is in most cases not worse than an episiotomy.

To perform an episiotomy, local anesthesia (numbing just the immediate area) is usually used. Just before the baby is born, the obstetrician makes an incision at the bottom of the vaginal opening. This enlarges the vaginal opening. The incision is closed after the baby and placenta have been delivered.

Indications

An episiotomy enlarges the vaginal opening to prevent tearing of more sensitive areas in the vaginal wall during birth.

Risks
Risks for any anesthesia include the following:

     
  • Reactions to medications  
  • Problems breathing

Risks for any surgery include the following:

     
  • Bleeding  
  • Infection

Expectations after surgery
An episiotomy usually heals without problems and may heal more quickly than a tear. It is also thought to help prevent vaginal stretching and to tighten the vagina after delivery.

Convalescence

An episiotomy usually heals without complications. Normal activities can be resumed shortly after birth. The stitches (sutures) will be absorbed by the body and do not need to be removed.

Proper hygiene and avoidance of constipation is advised (if possible). Pain and discomfort can be relieved with warm baths and medications.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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