An episiotomy is a surgical cut to enlarge the vaginal opening, while tearing is a natural rip during birth; modern evidence suggests natural tears often heal better and faster with less pain and complications than a routine episiotomy, which is now usually reserved for specific medical needs like assisted births or fetal distress, with both often requiring stitches, but episiotomies carrying a greater risk of extending to severe tears.
The degrees of an episiotomy are: First-degree: A small tear that involves just the lining of your vagina. Second-degree: A tear that extends through the lining of your vagina to the underlying vaginal tissue. Most episiotomies are second-degree.
But you may be wondering whether you'll heal faster after having an episiotomy or a natural tear during labor. Natural tears usually heal faster than episiotomies. Compared to an episiotomy, natural tears usually mean less pain, fewer complications, and quicker recovery. Episiotomies aren't routine anymore.
Like many historical shifts in doctor opinion, data drives why we no longer recommend routine episiotomies. The No. 1 reason the procedure has fallen out of favor is that it actually contributes to worse tearing than might occur naturally during childbirth.
Perineal grazes and tears are usually healing well after a couple of weeks. It can take up to a month for an episiotomy to heal and for the stitches to dissolve . Some women and birthing people find it helpful to use a mirror or take a photograph every few days to check on the progress of healing.
After having an episiotomy, it is normal to feel pain or soreness for 2-3 weeks after giving birth, particularly when walking or sitting. The stitches can irritate as healing takes place but this is normal. Pouring body-temperature water over the area when urinating can help.
Talk to your midwife or obstetrician about which activities you should avoid during the healing period.
Long-term effects of episiotomies can include: Chronic pain and infections. A small linear scar. Anorectal dysfunction.
After a vaginal birth, most pain from tears or soreness improves within one to two weeks, though mild discomfort may last a bit longer. After a C-section, incision pain can persist for weeks, with some women feeling tenderness or numbness for months.
Avoiding an Episiotomy
During the last month or two before your due date, perform Kegel exercises and perineum massages to strengthen and stretch the muscles of the pelvic floor. Making Kegels a part of your daily routine can make labor and post-birth recovery easier. Read about how to practice Kegel exercises here.
Women with episiotomy present higher pain intensity, less sexual satisfaction, greater changes regarding the orgasm's duration and intensity, lower levels of sexual arousal and total sexual function, than women with intact perineum.
While childbirth is famously painful, conditions like Cluster Headaches, severe Kidney Stones, Endometriosis, Trigeminal Neuralgia, and even intense dental procedures like root canals are often described by sufferers as worse, with cluster headaches frequently topping pain scales due to their intensity and lack of breaks, unlike labor. Pain perception is subjective, but these conditions involve excruciating, sharp, or prolonged agony that some individuals rate higher than childbirth.
Vaginal tears can be uncomfortable and painful, but most small vaginal tears heal within two weeks. It's common to feel discomfort for a month or two if your tear was larger. Third- and fourth-degree tears come with more complications due to the severity of the injury.
Episiotomy recovery is uncomfortable. Sometimes the incision is more extensive than a natural tear would have been. Infection is possible. For some, an episiotomy causes pain during sex in the months after delivery.
Second-degree tears involve skin and muscle in the area between the vaginal opening and the rectum. These tears may go deeper into the vagina. Second-degree tears typically require stitches. That often can be done in the delivery room.
A vaginal delivery is the safest and most common type of childbirth. Vaginal deliveries account for about 68% of all births in the United States.
Most episiotomies heal in 3 weeks. But it may take longer. This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace.
Your midwife or obstetrician may do an episiotomy to try to prevent a third or fourth-degree tear if: you're likely to tear. your baby needs to be born quickly or with help.
A numerical rating scale (NRS) of 0–10 was adopted to evaluate maternal pain, with 0 describing no labor pain and 10 describing the most severe labor pain. The higher the score, the more severe the labor pain is.
Most women heal after an episiotomy without problems, although it may take many weeks. Your stitches do not need to be removed. Your body will absorb them.
The procedure, used liberally after its introduction in the 1950's, was thought to prevent severe perineal tearing and long-term pelvic floor damage [2]. However, episiotomy became increasingly controversial as growing evidence demonstrated that its routine use caused worse perineal and vaginal trauma for women [3, 4].
Usually, when the healing process is complete, there will be a red scar for a short while. This will eventually fade like any skin scar. Re-sutured wounds heal a bit faster but there is a small risk that it will become infected again.
Don't wipe! Dab and use a peri bottle. Wiping can be irritating to the skin, using a peri bottle to clean after a bowel movement is gentle and will help in healing. Also, if you have hemorrhoids talk to your medical provider about soothing treatments you can use such as Tucks pads, aloe and/or coconut oil.
A healthy diet with plenty of fluids, vegetables and fruit rich in vitamin C, may help prevent constipation and also support wound healing.
Women assigned to the perineal/pelvic floor intervention showed a 31.63% reduction in episiotomy (Leon-Larios et al, 2017). Other ways to prevent episiotomies or perineal tears can include warm compresses on the area while pushing, proper breathing techniques, and possibly water births.