Episiotomy

What is an episiotomy, and why might I have one?

An episiotomy is a surgical cut in the perineum, the muscular area between the vagina and the back passage. Having an episiotomy used to be a routine part of labour (NICE 2007) but that's no longer the case. Your doctor or midwife might suggest one if your baby is becoming distressed and needs to be born quickly, or if she thinks that you may tear very badly unless the opening from the vagina is carefully enlarged.

Most doctors and midwives now try very hard to avoid doing episiotomies. Having an episiotomy can cause problems with pain, incontinence and poor healing, with very few benefits for either you or your baby. So your doctor or midwife will only offer you an episiotomy if she feels that you or your baby will clearly benefit from the procedure (NICE 2007).

Will I be able to choose whether to have an episiotomy?

If you feel strongly that you don't want an episiotomy, talk to your doctor or midwife at one of your prenatal appointments, and write your preference down on a birth plan.

Learning how to relax while you are giving birth and how to use different positions to help your baby be born will help you to avoid having an episiotomy. Prenatal classes are useful for learning more about this.

Does having an episiotomy hurt?

Most women say that they didn't feel anything when their episiotomy was performed. The tissues around the vagina are tightly stretched when you are giving birth, and a cut can be made very easily.

An episiotomy always needs to be sewn up (after the birth of the placenta) by either a midwife or doctor. Your midwife or doctor will put your legs in stirrups so that she can see effectively. If you do not already have an epidural in place, your midwife or doctor will give you a local anesthetic into your perineum so you should feel no pain at all during stitching. If you feel something, tell your midwife or doctor that you need more pain relief.

However, recovering from an episiotomy can be quite painful.

My stitches are sore. How can I ease the pain?

There are a number of ways in which you can help yourself:

• Place a cooled gel pad, ice-pack (or package of frozen peas!) on your stitches. The ice will numb the area and prevent or reduce swelling. "Cold therapy" has long been considered a safe way of reducing the pain of bruised tissues (East 2007).
• Have a warm bath. (There's no evidence that putting salt in the water helps your stitches to heal.) Pat your stitches dry with a clean soft towel.
• Try to expose your stitches to the air. Take your underwear off and rest on your bed with an old towel underneath you for ten minutes or so once or twice a day.
• Walk around as much as possible and practise your pelvic floor muscle exercises to stimulate circulation and speed healing.
• Apply witch hazel with a cotton facecloth or on a compress.
• Take acetaminophen.

If nothing seems to help with the pain, you may have an infection. Talk to your doctor or midwife who can check that everything is OK and that your stitches are healing properly.

How long will my episiotomy take to heal?

Your stitches should not take more than a month to heal.

If you're in any doubt as to whether your stitches have healed properly, go and see your doctor, or wait for your six week check-up and ask her to look at your perineum then.

When can I have sex again?

Once your stitches have healed it's fine to make love as long as both you and your partner feel like it.

When you first make love, you may feel some initial tenderness and tightness. Relaxing as much as possible and using a lubricant, such as K-Y Jelly, will help make you more comfortable. Try having a glass of wine and taking a warm bath before you go to bed, and leave plenty of time for foreplay. You may prefer to be on top so that you can control the degree of penetration, or you may find that the side-lying position is the most comfortable.