Episiotomy

• Description

  Just before the baby is born, the obstetrician numbs the vaginal area opening and makes one of two cuts:

  • A mediolateral cut is angled down away from the vagina and into the muscle.
  • A midline cut is made straight down between the vagina and anus.

  The cut makes the opening to the vagina bigger. The cut is stitched closed after the baby and placenta have been delivered.

• Why the Procedure Is Performed

  Episiotomies were once routinely performed to prevent vaginal tears during delivery. Today, routine episiotomies are not recommended.

  However, episiotomies may still be performed when there is a complicated delivery. An episiotomy may be needed if the baby's head or shoulders are too big for the mother's vaginal opening, or the baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.

  It may also be needed to speed the delivery process if there is concern about the baby's heart rate.

• Risks

  Many studies have found that the procedure offers no benefit in routine deliveries, and there is no evidence to suggest that it improves a woman's sexual function. It has also been found that women who have an episiotomy have more intercourse-related pain after pregnancy and take longer to resume having sex after childbirth.

  If an episiotomy cut is made, there is more of a chance that it will become a larger tear or even extend into the muscles around the rectum. This can lead to later problems with controlling gas and sometimes stool. When no episiotomy is made and a woman is just allowed to tear, these problems are less likely to happen.

  Additional risks include:

  • Bleeding
  • Bruising
  • Incontinence
  • Infection
  • Swelling
• After the Procedure

  An episiotomy usually heals without problems and may be easier to repair than multiple tears.

• Outlook (Prognosis)

  You can resume normal activities shortly after the birth. The stitches are absorbed by the body and do not need to be removed. You can relieve pain and discomfort with medication and ice in the first 24 hours, followed by warm baths.

• References

  Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA. 2005 May 4;293(17):2141-8.

  American College of Obstetricians-Gynecologists. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Practice Bulletin. April 2006: Number 71.

  Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews 2009, Issue 1, Art. No.: CD000081. DOI: 10.1002/14651858 CD000081.pub2.

  Frankman EA, Wang L, Bunker CH, Lowder JL. Episiotomy in the United States: has anything changed? Am J Obstet Gynecol. 2009;200:573.e1-573.e7.

Review Date: 9/2/2009

Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.