What is an episiotomy and will I have to have one?

If you’re planning a vaginal birth (or have ever sat in on a mother’s group conversation) then chances are you’ve heard the term, episiotomy come up. It’s often accompanied by shivers and sympathetic grimaces.

What is an episiotomy?

An episiotomy is a small surgical incision made in the perineum (the layer of tissue between the vaginal opening and the anus) during childbirth to enlarge the opening and help guide the baby through. While once considered a routine part of childbirth, these days they are generally only recommended in cases of ‘fetal distress’ and birth is required quickly.

An episiotomy is usually done to prevent tearing and is more common in breech births, long labour, if the mother’s health is at risk or when the baby’s heart rate rises.

They may also be performed if forceps or vacuums are required to help coax the baby out. 

How is an episiotomy performed?

Your doctor or midwife will perform the procedure and will either top up your epidural if you have one or provide some local anaesthetic to help numb the pain so you cannot feel it.

There are generally two types of incisions:

• Midline incision is a vertical incision, and is often easier to repair, however there is risk of it extending to the anus.
  
• Mediolateral incision is done at an angle and means you have less risk of the tear extending to anus, but can be more difficult to repair and also more painful.

Following the birth of your baby, your doctor or midwife will then stitch up the incision with dissolvable stitches.

What is the recovery like?

As the doctor/midwife uses invisible stitches there should be no follow-ups required, however, recovery can take anywhere up to 6 weeks and can be quite painful.

As with any surgery, there will likely be some bleeding afterwards. This should ease off within the first few days and the stitches should heal and disappear within approximately a month.

It is normal to feel pain down there for a few weeks, especially when you go to the toilet, speak with your doctor/midwife about the best ways to manage it.

If the pain is getting worse, bleeding doesn’t stop or you develop a fever or rash, contact your doctor immediately.

Are there any risks or side effects?

As mentioned above, there is a risk that the incision will extend down to the anus, also known as fourth-degree vaginal tearing and can lead to fecal incontinence – but this is uncommon.

There is also the risk of infection during the recovery, and pain during sex in the months following the birth.

Speak to your doctor or midwife in the lead up to the birth about their thoughts on episiotomies and ask them any questions as well as raise any concerns you may have. While they will do what they feel is best in the situation – as they are there to look after you and your baby and if there are complications they will do what they have to do – but it doesn’t hurt to have the conversation in advance.

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