An episiotomy is a surgical procedure that involves making a small incision in the perineum (the area between the vaginal opening and anus) to widen the opening of the vagina while giving birth.
It is done to help with the delivery of the baby or to avoid extensive vaginal tearing and trauma.
Episiotomy can be classified into four types:
- Mediolateral:
- The incision is made to the right or left side from the midpoint of the fourchette (a thin fold of skin at the back of the vulva).
- It runs diagonally in a straight line about 2.5 cm away from the anus.
- Median:
- The incision begins in the center of the fourchette (a thin fold of skin at the back of the vulva) and extends for 2.5 cm on the posterior side along the midline.
- Lateral:
- The incision begins about a centimeter away from the center of the fourchette (a thin fold of skin at the back of the vulva) and extends laterally.
- Because of the risk of injury to the Bartholin's duct (secretes fluid that helps lubricate the vagina), some practitioners strongly advise against lateral incisions.
- J-shaped:
- The incision begins in the center of the fourchette (a thin fold of skin at the back of the vulva) and is directed posteriorly along the midline for about 1.5 cm before being directed downward and outward along the 5 or 7 o'clock position to avoid the internal and external anal sphincters.
- This procedure is not widely used.
Degrees of an episiotomy is used to document the type of birth cut a woman received to deliver a baby. The degree is determined by the tissues that were lacerated. This assists in guiding management and possible long-term symptoms and outcomes.
- First-degree episiotomy: This cut only penetrates the vaginal epithelium (the tissue lining the vagina).
- Second-degree episiotomy: This episiotomy goes through the perineum muscles but bypasses the anal sphincter.
- Third-degree episiotomy: Only the skin and muscle of the perineum are invaded during an episiotomy. However, in third-degree episiotomy, this can occasionally progress to third or fourth-degree laceration. The tear in this case passes through the perineal muscles and external anal sphincter.
- Fourth-degree episiotomy: This is when laceration passes through the perineal muscles, external anal sphincter, and inner rectum lining.
One of the reasons for the decrease in episiotomy placement is to avoid these extensions and the damage they cause.
What occurs during an episiotomy?
The type of episiotomy and procedure itself may differ depending on the mother’s condition, but an episiotomy generally follow the process outlined below:
- The episiotomy is best done at crowning (when the fetal head pushes against the perineum and is visible). This puts pressure on the perineal nerve and numbs the area; thus, anesthesia is not needed for the cut.
- The doctor cuts with episiotomy scissors.
- After the episiotomy, the baby will be delivered through the enlarged vaginal opening.
- After that, the placenta (afterbirth) will be delivered.
- The doctor will then inspect the incision to look for any additional tearing that may have occurred during the birth.
- The incision to the perineal tissue and muscle is then repaired in layers with dissolvable stitches (sutures)—inner soft tissue, muscle, and skin are sutured separately.
Complications that can occur due to an episiotomy include:
- A second tear in the incision, may extend to the rectum and affect the anal sphincter muscle that controls stool passage
- Blood loss due to the incision and blood collection in the perineal tissues
- Risk of infection in the cut
- Painful sex for a few months after giving birth
Despite the risks, an episiotomy may be necessary in some cases for safe delivery.
Discuss episiotomy with your doctor before giving birth to ensure that you are both comfortable and informed.
SLIDESHOW
Conception: The Amazing Journey from Egg to Embryo See SlideshowHow is the recovery period after an episiotomy?
Recovery from an episiotomy can be uncomfortable, if not painful. The degree of pain will be determined by the length and depth of the incision.
- Pain is most noticeable when you walk or sit, but it can interfere with urination and bowel movements for at least a week.
- The first bowel movement after an episiotomy can be excruciatingly painful for some women.
- Pain from an episiotomy can last for several weeks, whereas tenderness from a large incision or tear can last much longer.
- Stitches that were used to close the episiotomy will dissolve on their own.
To aid in your recovery, your doctor may recommend over-the-counter or prescription medications that may include:
- Painkillers
- Anti-inflammatories
- Stool softeners
- Anesthetic spray
- Antibiotics
Although episiotomy was once a routine part of normal childbirth, with advances in knowledge, it is now only recommended in certain cases. As a result, episiotomy rates have dropped significantly in recent years worldwide.
The episiotomy rate is difficult to determine although some studies have reported that it may range between 53 and 77 percent but can be as high as 92 percent in private hospital deliveries. Doctors no longer advise episiotomy regularly.
If the baby needs to be delivered quickly, your doctor may advise you to have an episiotomy.
They may also advise an episiotomy under the following circumstances:
- The Baby’s shoulder is stuck behind the pelvic bone (shoulder dystocia)
- Baby has an abnormal heart rate pattern during your delivery
- Mothers may sometimes need an operative vaginal delivery (using forceps or vacuum)
Health News
- CDC Warns of Potentially Fatal Bacterial Illness on U.S. Gulf Coast
- Helping Others as Volunteers Helps Kids 'Flourish': Study
- FDA Approves Pfizer's RSV Shot for Older Adults
- What to Do When Tough-to-Treat Lymphoma Strikes During Pregnancy
- Rate of Pregnant U.S. Women Who Have Diabetes Keeps Rising
More Health News »
Health Solutions From Our Sponsors
Classification of episiotomy: towards a standardisation of terminology: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03268.x
Episiotomy and Repair Technique: https://emedicine.medscape.com/article/2047173-technique
Episiotomy: https://www.ncbi.nlm.nih.gov/books/NBK546675/
Episiotomy: Techniques and Indications: https://collections.lib.utah.edu/dl_files/fd/2a/fd2a4f9f7b46976e17792e4ab5ee78ff1d2c6a48.pdf
Top What Are the 4 Types of Episiotomy Related Articles
Childbirth Delivery Methods and Types
Learn about the pros and cons of various childbirth methods, such as the Bradley method, C-section, natural childbirth, water birth, Lamaze, and vaginal delivery. Read about birthing centers, hospital and home births, midwives, and doulas.What Are the Advantages and Disadvantages of a Hospital Birth?
Many women give birth in a hospital, birthing center, or at home. The advantages of a hospital birth include pain control, access to a NICU, staff support, and availability of interventions. Disadvantages include stress, fewer birthing positions, fewer support people, and you may not be able to choose your delivery doctor.
Childbirth Class Options
Childbirth class options include the Lamaze technique, the Bradley Method, the Alexander Technique, and HypnoBirthing.
16 Early Signs & Symptoms of Pregnancy: Could You Be Pregnant?
What are the early signs and symptoms of pregnancy? Can you know before your missed period? Read about nausea and vomiting (morning sickness), bloating, tender breasts, and more. Explore first trimester symptoms of pregnancy and learn what week pregnancy symptoms start.
Ectopic Pregnancy (Tubal Pregnancy)
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Signs and symptoms of an ectopic pregnancy may include abdominal pain, lack of menstrual period (amenorrhea), vaginal bleeding, fainting, dizziness, and low blood pressure.
Treatment options for an ectopic pregnancy include observation, medication, or surgery.
Episiotomy
Episiotomy is a procedure in which an incision is made between the vagina and anus, in the aid in the delivery of a baby. Complications of episiotomy include bleeding, swelling, local pain, infection, defects in the would closure, and possibly short-term sexual dysfunction.
Exercise & Pregnancy
Pregnancy exercises and workouts for moms-to-be include Kegel exercises and prenatal yoga. A prenatal workout is an important part of healthy living. Try these safe exercises for pregnancy.
Labor and Delivery
Early and later symptoms and signs of labor and delivery are unique to each woman. Early signs of labor are "lightning" and passing the mucus plug. Later symptoms and signs that labor that labor is are the woman's water breaking, and when contractions begin. There are three stages of labor, stage 1 is the longest and occurs when the cervix begins to thin and dilate. During stage 2 of labor the baby passes through the birth canal and remains there until delivery, and stage 3, is when the baby is delivered.
Natural Birth Control
Natural methods of contraception are considered "natural" because they are non-mechanical and non-hormonal. Fertility awareness methods (FAMs) are based upon knowing when a woman ovulates each month. Natural methods of birth control include: the calendar rhythm, basal body temperature, mucus inspection, symptothermal, use of an ovulation indicator testing kit, withdrawal, lactational infertility, douching and urination, and abstinence.
Pregnancy: Multiple Births, Twins, Triplets, and More
Multiple births occur when a woman bears twins, triplets, or even more babies during pregnancy. More multiples are born today thanks to assisted reproductive technology (ART), including in vitro fertilization using fertility drugs. Women carrying multiples often give birth via C-section.
Pregnancy Myths and Facts Quiz
Being pregnant is a delicate time for both mother and baby. Take this pregnancy myths and facts quiz to separate the myths and facts about being pregnant, and learn the truth behind healthy pregnancies!
Pregnancy Planning (Tips)
Pregnancy planning is an important step in preparation for starting or expanding a family. Planning for a pregnancy includes taking prenatal vitamins, eating healthy for you and your baby, disease prevention (for both parents and baby) to prevent birth defects and infections, avoiding certain medications that may be harmful to your baby, how much weight gain is healthy exercise safety and pregnancy, travel during pregnancy.
What Foods Should I Eat During My First Trimester of Pregnancy?
What to know about diet during the first trimester. Learn more about how to protect and fuel your body and baby during this exciting time.
Pregnancy: 7 Common Third Trimester Tests
Testing is often recommended during the third trimester of pregnancy. These tests are designed to ensure the health and safety of both the child and mother. Common tests during the third trimester of a woman's pregnancy include:- group B streptococcus screening,
- electronic fetal heart monitoring,
- nonstress test,
- contraction stress test, and
- a biophysical profile.
Tubal Pregnancy Picture
A pregnancy that is not in the usual place within the uterus but is located in the Fallopian tube. See a picture of Tubal Pregnancy and learn more about the health topic.
What Is More Painful C-section or Natural Birth?
Ultimately, a natural birth may be more painful than a cesarean section. However, the pain after your cesarean section combined with the heightened risks to you and your baby may outweigh the initial pain of childbirth.