Episiotomy

An episiotomy is an incision made between the vagina and the rectum in order to increase the size of the opening of the vagina and facilitate the delivery of a baby.

An episiotomy is performed in a large percentage of vaginal deliveries in the United States, but the prevalence of episiotomy has been decreasing in recent years. Some countries have significantly lower episiotomy rates than the U.S. In general, episiotomy is less common in Europe than in the U.S.

The usual cut (incision) for an episiotomy goes straight down and typically does not involve the muscles around the rectum or the rectum itself. Anesthesia in the form of nerve blocks or local injections of anesthetic are given if the patient has not received regional anesthesia (such an epidural) for the delivery.

An episiotomy can decrease the amount of pushing the mother must do during delivery. It can also decrease trauma to the vaginal tissues and expedite delivery of the baby when delivery must be accomplished expiditiously. Doctors who favor episiotomies argue that a surgical incision is easier to repair than a spontaneous irregular or extensive tear, and is likely to lead to a more favorable outcome with fewer complications.

The repair is straightforward and is fairly simple to perform. The incision is repaired by suturing (sewing) the wound together.

Episiotomy can be associated with extensions or tears into the muscle of the rectum or even the rectum itself. Other complications can include:

• bleeding,
• infection,
• swelling,
• defects in wound closure,
• localized pain, and
• sexual dysfunction (usually transient).

Studies have shown conflicting results regarding the question of whether performing an episiotomy results in greater postpartum pain than not performing the procedure.

However, it is important to note that if the baby needs to be delivered more urgently, then waiting for the mother to push it out without the assistance of an episiotomy may in certain cases cause harm to the fetus. Also, there are some tears that occur when no incision is made that are very difficult to repair and cause greater blood loss than might otherwise occur.

The American College of Obstetricians and Gynecologists supports the position of restricted, instead of routine, use of episiotomy. Instead, episiotomy should be considered in certain situations when there is a high risk of severe lacerations or the need to facilitate rapid delivery of a fetus.

The typical healing time for an episiotomy is around 4 to 6 weeks depending on the size of the incision and the type of suture material used to close the wound.