Episiotomy

What is an episiotomy?

An episiotomy is a surgical cut made in your perineum (the tissue between your vagina and anus) during childbirth. You doctor or midwife may do this to make more space for your baby to be born.

An episiotomy may only be done with your consent.

An episiotomy is done to reduce your risk of having a severe tear in your vagina or perineum.

What is a perineal tear?

Perineal tears are tears of the skin and tissues that separate your vagina and anus. They can happen during childbirth as your baby stretches your vagina and perineum during birth.

Many women experience spontaneous vaginal tears during childbirth. In most women, these tears are small and heal quickly.

Why might I need an episiotomy?

Your doctor or midwife may recommend an episiotomy during a vaginal birth.

This may be:

• to prevent severe perineal tearing or trauma during an assisted birth
• because your baby has become distressed (is showing signs they may not be well) — an episiotomy can help birth your baby more quickly.
• there is a likelihood of a severe perineal tear.

An episiotomy is not recommended for every birth.

When might an assisted birth be needed?

An assisted birth (using forceps or vacuum) may be recommended in situations such as:

• your baby is unwell or in distress and needs to be born quickly
• your baby is in a position that makes it difficult for them to be born
• you are becoming exhausted and are unable to continue pushing
• you have a medical problem that means you shouldn't push during labour

How is an episiotomy done?

Your doctor or midwife will give an injection of local anaesthetic to numb the skin around your perineal area. This is so you don’t feel pain from the cut.

They will make a cut in your perineum with surgical scissors. This makes the opening to the vagina wider.

After giving birth, you will need stitches.

You may be sore once the local anaesthetic has worn off. You will be offered ice packs and pain-relief medicines to reduce swelling and discomfort.

What can I do during my pregnancy to reduce my chance of needing an episiotomy?

Massaging your perineum during late pregnancy may help stretch your perineum. It may reduce your chances of needing an episiotomy.

Perineal massage is usually started at about 35 weeks of pregnancy in women planning a vaginal birth. It’s continued right up until the birth. Talk to your doctor or midwife about how to do perineal massage if you would like to use this technique.

You should avoid perineal massage if you have:

• a short cervix
• a low-lying placenta or placenta praevia
• bleeding from your vagina
• severe blood pressure problems in pregnancy
• an active genital infection (for example, herpes or thrush)
• ruptured membranes (your waters have already broken)

It is also a good idea to talk to your midwife or doctor about your risk factors and the strategies used in your chosen hospital or birth centre to reduce the likelihood of sustaining a serious tear.

What if I don’t want an episiotomy?

An episiotomy is only done when you give consent. Consent is when you agree to have certain care or treatment. It’s part of shared decision making — where you make informed decisions together with the doctors and midwives looking after you.

Talk with your midwife or doctor before the birth and let them know your birth preferences.

While your healthcare team will try to meet your expectations, sometimes unexpected situations happen during labour and childbirth.

If there are complications during your labour where an episiotomy may be recommended and you don’t want to have one, your healthcare team will advise you on the risks and benefits of this.

What happens after an episiotomy?

If you agree to have an episiotomy, your doctor or midwife will stitch your episiotomy soon after birth. They will use dissolvable stitches. This means that you don’t need to have the stitches removed later. You will be offered ice packs and pain-relief medicines to reduce swelling and discomfort.

How long does it take to recover from an episiotomy?

The stitches usually dissolve in 1 to 2 weeks. You can use ice packs to help to reduce swelling in the area and take pain-relief medicines to help manage discomfort.

It may take a few weeks to fully recover.

You can have sex again when you feel comfortable doing so. It’s normal to take several weeks or months before you are ready. There is no standard waiting period before women can resume sex after having a baby. However, most maternity care providers recommend waiting until after the bleeding has stopped and your perineum has healed.

What can help my recovery after having an episiotomy?

There are a few things you can do to help support the healing of your perineal area. Keep in mind that everyone is different, and it is always best to follow the instructions of your healthcare team:

• Try to rest as much as possible and lie on your side if you can.
• Avoid positions and activities that place pressure on the muscle or restrict blood flow to the area, like sit-ups, lifting and high impact exercise.
• Keep the tear clean and dry — shower daily and gently pat the area dry.
• Avoid using any cream ointments or powder on the area, unless you’ve been advised to by your healthcare provider.
• Change your pads frequently.
• Start gentle pelvic floor muscle exercises 2 to 3 days after your baby’s birth, or when it’s comfortable for you to do so.
• Avoid becoming constipated, drink plenty of water and try to eat a diet rich in fibre (fruit, vegetables and wholegrains).
• Take your time when emptying your bladder and bowel and avoid pushing or straining.
• Use a foot stool or lift your heels up so that your knees are above your hips when you’re sitting on the toilet.
• Try to keep well hydrated so your urine is less concentrated. This can help reduce stinging.
• Try leaning forward on the toilet when you pass urine, this will keep the urine away from the tear and reduce stinging.

Learn more about scar healing and recovery.

Are there any potential complications from an episiotomy?

Infections

If you notice any signs of infection, or are concerned, contact your doctor or midwife. Signs of infection can include:

• swelling
• discharge of pus of liquid from the scar
• ongoing pain
• an unusual smell

Pelvic floor muscles

After birth, some women have a weakened pelvic floor. This may cause bladder weakness in the first few weeks after birth.

A physiotherapist can help to guide you on how to strengthen your pelvic floor muscles after birth with pelvic floor exercises.

Mental health

Recovering from an episiotomy will mean different things for different people. The emotional impact of a birth trauma is often due to a difference between what you expected to what actually happened. It can also affect your non-birthing partner.

Learn more about the emotional impacts of birth trauma and how you can recover.

Will an episiotomy affect my future births?

Having an episiotomy does not always mean that you will need an episiotomy for future births.

Discuss the risks and benefits of having an episiotomy with your doctor or midwife. Having this discussion during pregnancy will help you to make decisions during labour and birth.

When should I see my doctor?

Most women are advised to have a postnatal check 6 weeks after their baby’s birth.

See your doctor earlier if you are concerned about how your perineum is healing or if you have other concerns with your vagina, bladder or bowel after birth, such as:

• you develop a temperature
• you notice an unusual smell or discharge from the tear
• your perineum becomes inflamed, swollen and red
• your perineal tear is still causing you pain after 2 to 3 weeks
• you cannot control your bowels or passing wind
• sex is painful for you
• you have a heavy, dragging sensation in your vagina

Who can I speak to if I'm not satisfied with my healthcare?

If you aren’t satisfied with your healthcare, there are many people you can speak to, including:

• your doctor or midwife
• the health complaints agency or health department in your local state or territory
• the Australian Health Practitioner Regulation Agency (AHPRA), if you have a concern about the unsafe behaviour or practice of a registered health practitioner
• the National Health Practitioner Ombudsman

If you aren’t sure about something that happened to you, especially during labour, birth or in an emergency, it’s a good idea to ask your doctor or midwife for a debrief. This is an opportunity to ask questions after an event, so that you better understand what happened.

Resources and support

Talk to your doctor, midwife or obstetrician if you have any questions or concerns about your recovery.

Visit the Australasian Birth Trauma Association website for information and support, including peer-to-peer support.

Visit the Perinatal Anxiety and Depression Australia (PANDA) website for information and support after a traumatic or complicated birth. You can call the PANDA National Helpline on 1300 726 306.

The Continence Foundation of Australia offers information and support to people with bowel and bladder problems. You can call the helpline on 1800 33 00 66 between 8am and 8pm (AEST), Monday to Friday.

ForWhen on 1300 24 23 22 (Monday to Friday 9am to 4:30pm).

Beyond Blue on 1300 22 4636.