Will I Need an Episiotomy?

Will I Need an Episiotomy?

An episiotomy is no longer recommended for all moms-to-be in all cases. Here’s what to know about this once-routine childbirth procedure:

What is an episiotomy?

An episiotomy is an incision made through the area between the vaginal opening and anus (perineum) during childbirth. For years, the procedure was believed to help prevent more extensive vaginal tears, as well as promote better healing overall compared to natural tearing. Current research suggests this may no longer be true.

“Episiotomies have actually been shown to be associated with a higher chance of more severe tearing during delivery,” said Kami Palmer, MD, Ob/Gyn Associates of Holland. “However, there are situations where they are warranted and can be safely performed.”

When might an episiotomy be recommended?

A health care provider might recommend performing an episiotomy if he/she suspects a bad tear is unavoidable, or the baby has an abnormal heart rhythm or other signs of fetal distress. “If a baby’s in distress and needs to be delivered quickly, an episiotomy may be appropriate and would offer lower risk than performing a C-section,” Dr. Palmer said.

Are there different types of episiotomies?

There are two types of episiotomy incisions:

  • Midline: straight down from the vaginal opening.
  • Mediolateral: performed at an approximate 45-degree angle from the base of the vaginal opening.

The American College of Obstetricians and Gynecologists (ACOG) states if episiotomy is performed, “mediolateral may be preferred, because it is associated with a lower risk of extending into the rectal muscle and rectum.”

“Mediolateral episiotomy has less risk of fecal incontinence than midline episiotomy,” Dr. Palmer said. “Should you need an episiotomy, you should ask your provider which type they perform, and whether mediolateral would make sense for you.”

What are the risks of episiotomy?

  • Scarring
  • Pain with healing
  • Bowel incontinence
  • Dyspareunia (difficult or painful sex)
  • Infection (rare)
  • Extended tearing into muscle around or into rectum

Can an episiotomy be prevented?

Yes, sometimes with these prevention techniques:

  • Eating well—maintaining a healthy pregnancy weight can help prevent a large gestational age baby (larger babies may increase the likelihood of requiring an episiotomy).
  • Perineal massage.
  • Warm compresses applied during delivery.
  • Gently stretching the skin with baby soap as the mother pushes in delivery.

“With the right support, we’re able to help most of our expecting moms avoid having an episiotomy,” Dr. Palmer added. “I’m proud to say the episiotomy rate for 2019 at Holland Hospital is less than 2%. That’s lower than the national average.”

Are there any recovery tips?

To ease any discomfort during recovery, some self-care tips include:

  • Placing an ice pack/cool compress on the perineum.
  • Soaking with Epsom salt. Allow soap and water to run over area and gently pat dry. Do not scrub.
  • Using a topical spray (e.g., Dermoplast) for pain relief.
  • Not having sexual intercourse for at least six weeks and after you have seen your provider for a postpartum exam.
  • Avoiding harsh wiping after urination or a bowel movement. Use a peri-bottle to cleanse the area and gently pat dry.

Are you a mom-to-be? From expert staff to state-of-the-art facilities to family-focused care, Holland Hospital’s Boven Birth Center delivers exceptional birth experiences.


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