Episiotomy

Some women may need an episiotomy during labour. This is a procedure when your midwife or doctor will make a cut in your perineum to enable your vagina to stretch further and allow baby to pass through easier. Your perineum is the area between your vagina and anus.  You will be given a dose of local anaesthetic prior to the procedure or if you have had an epidural, your dosage will be topped up to allow the episiotomy to be carried out without you feeling any pain.

The main reasons for you to need an episiotomy include:

  • There is a risk that your perineum is not stretching enough to allow baby to pass through and is therefore being severely torn. If your perineum tears without help, the wound may be larger and therefore more difficult to repair and more prone to infection.
  • A quick childbirth is needed as there may be a risk to your baby’s health
  • You are going to need an assisted birth such as ventouse or forceps
  • Your baby is in breech (feet first) position.
  • Your baby has not turned enough and his shoulder has got stuck
  • You have been in labour for many hours and are exhausted
  • If you have a health condition and need a quick childbirth to prevent risk
  • If in a previous labour, you suffered severe scarring in your vagina due to a tear in your perineum

If you need to have an episiotomy or if you tear during your labour, it will need repairing, usually within an hour of the baby’s birth. Your midwife will use dissolving stitches meaning that you will not need to return to hospital to have them removed. Stitches normally heal within one month.

You may feel some pain where the cut was made for up to two weeks. Passing urine can also sometimes cause the wound to sting. Many women agree that there is little pain when the episiotomy is performed but that it does take time to recover from having an episiotomy and also from having it stitched back up. There are several things that you can do to help the healing process, including:

  • Painkillers: Both paracetamol and ibuprofen are safe to use if breastfeeding
  • Ice: Many women wrap ice or an ice pack in a towel and hold it on the incision position.
  • Air: Exposing the stitches to the fresh air can speed up the healing process. Try removing your underwear and lying on a towel one or two times each day
  • Using a doughnut shaped cushion or a valley cushion to support you when sitting
  • Have a warm bath as warmth and water can aid pain relief
  • Keep the incision area clean to avoid infection
  • Pouring warm water over the outer area of vagina whilst urinating can help with the stinging sensation
  • Some women prefer to squat over the toilet rather than sit on it as this helps reduce the stinging
  • If you are passing a stool, you may want to press a clean pad upwards as you are pushing down – this relieves pressure on the wound.
  • If passing stools is difficult, your midwife may suggest a laxative to help soften your stools.
  • Continue you pelvic floor exercises as these strengthen the muscles around the cut.

When your stitches have healed, it is perfectly safe to have sex as long as both you and your partner want to. You may feel especially tender and tight when you first begin. Try and relax as much as possible and you may find using a lubricant to help make you feel more comfortable.  A warm bath may help as well as plenty of foreplay.  Many find lying side by side is the most comfortable position to try at first.

If you are at any time concerned or worried, speak to your midwife who will examine the area and ensure you are healing correctly.

by Jenny, mum to William and James

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