What is an episiotomy?

An episiotomy is a cut made to the perineum, the tissue between the vagina and the anus to widen the vaginal opening during birth.

Why might I need an episiotomy?

You doctor or midwife may recommend an episiotomy to prevent perineal tearing or trauma during an assisted birth.

An assisted birth (using forceps or vacuum) may be recommended in several situations. For example, your baby may not be moving through the birth canal as quickly as expected (this is called the prolonged second stage), there may be concerns about your baby’s wellbeing or you may be unable to keep effectively pushing.

Episiotomies may also be needed if your baby becomes distressed. Your baby may have a heart rate that is too high or too low, which can be a sign that your baby’s wellbeing is compromised. If so, you may need an episiotomy to help birth your baby more quickly.

Your doctor or midwife may also recommend an episiotomy if there is a likelihood of a severe perineal tear. Perineal tears are tears of the skin and other tissues that separate the vagina from the anus. They can happen during childbirth as the baby stretches the vagina and perineum during birth.

Serious perineal tears (third and fourth degree tears) are more likely to occur during first births, in an assisted birth or if your baby has a high birth weight. Other risk factors include women of south Asian ethnicity, a prolonged second stage of labour and shoulder dystocia (when one of the baby’s shoulders gets stuck during birth).

How is an episiotomy done?

A doctor or midwife will use local anaesthetic to numb the skin around your perineal area before the episiotomy so you don’t feel pain from the cut. Then they will cut through the skin and muscle layers with surgical scissors. After the birth you will need stitches to close the episiotomy. You may be sore once the local anaesthetic has worn off. You will be offered ice packs and pain-relief medication 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 can help stretch your perineum and reduce your chances of perineal tears and the need for episiotomy. There are several different perineal massage techniques. It’s a good idea to talk to your midwife or doctor for more information if you are unsure. You should only do perineal massage if you are at low risk of doing so, have a normal pregnancy and feel comfortable doing so.

You or your partner can start massaging your perineum from about 35 weeks of pregnancy, 1 to 2 times each week. Each session should last for a maximum of 5 minutes. Insert 1 or 2 lubricated fingers approximately 5cm into the vagina and apply gentle pressure downward (toward the anus) and to the side of the vagina until you feel a slight tingling or burning sensation. Hold this stretch for about 2 minutes. You can do a perineal massage while you are sitting, lying down or standing — whatever feels comfortable for you. You can use massage oil or water-soluble vaginal lubricants.

It’s best to avoid a perineal massage in the following situations:

• before 34 weeks of pregnancy
• if you have a short cervix
• if you have a low-lying placenta or placenta praevia or if you have any condition involving bleeding from your vagina during the second half of pregnancy
• if you have severe blood pressure problems in pregnancy
• if you have an active vaginal infection (for example, herpes or thrush).

Are there any risks to my baby if I have an episiotomy?

An episiotomy will not cause any harm to your baby.

What if I don’t want an episiotomy?

An episiotomy is only recommended if needed and when the mother gives verbal consent. 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. An emergency caesarean section may be recommended instead.

How long does it take to recover from an episiotomy?

A doctor or midwife will stitch your episiotomy soon after birth. They will use dissolvable stitches. This means that you don’t need to get the stitches removed later. They will dissolve in 1 to 2 weeks. You can use ice packs to help to reduce swelling in the area, and take pain-relief medications to help manage discomfort.

It may take a few weeks to fully recover. Wash the area in the shower and gently pat it dry. During the first few days, remember to sit down gently and lie on your side rather than on your back. If you notice any signs of infection, or are concerned, contact your care provider.

You can have sex again when you feel comfortable doing so. It’s normal to take several weeks or months before you are ready.

Learn more about scar healing and recovery.

Are there any lasting effects of an episiotomy?

An uncomplicated episiotomy should heal in 1 to 2 weeks. Some women may have complications, including wound healing problems or infection. If this occurs, see your healthcare provider where you gave birth.

After birth, some women have a weakened pelvic floor. This may cause bladder weakness in the first few weeks after birth. If this does not resolve, or if you are experiencing other health issues such as incontinence, continuing pain around your episiotomy, a dragging or heavy feeling in the pelvis or pain during sex, you should see your pregnancy care provider or GP.

A physiotherapist can also help to guide you on how to care for your pelvic floor after birth and give you exercises to strengthen your pelvic area.

Will an episiotomy affect 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.

What resources and support are available?

• Talk to your doctor, midwife or obstetrician.
• 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.
• 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 birth. You can call the PANDA national helpline on 1300 726 306 (Mon to Fri, 9am to 7.30pm AEST).