An episiotomy cut is usually 3–4 cm long, made at an angle (mediolateral) from the vaginal opening (fourchette) downwards and outwards, often around 60 degrees from the midline, to avoid the anus and protect the anal sphincter, though a midline (vertical) cut is also possible but has higher risk of extension. The exact size and angle depend on the type (mediolateral is common) and clinical need, aiming to prevent worse tearing.
An episiotomy is a 2.5–5 cm incision (cut) that is made in the lower vagina to widen the vaginal opening and facilitate the passage of the baby during childbirth.
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.
Types of episiotomy incisions
Median (midline): A vertical (up and down) incision beginning at the vaginal opening extending toward the anus. This type has a higher risk of tearing to the anal sphincter or rectum, but is an easier incision to make. Mediolateral: An angled or diagonal incision.
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.
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.
Long-term effects of episiotomies can include: Chronic pain and infections. A small linear scar. Anorectal dysfunction.
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.
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.
First, the delivering provider should examine the extent of the laceration after delivery, carefully evaluating for possible extension to third- or fourth-degree laceration. Either 2-0 or 3-0 sutures (of the same materials as used for midline episiotomy) may be used for the repair.
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.
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.
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Typically, the distance from the vaginal opening to the cervix is between 3 and 7 inches.
Episiotomy Care
Squeeze the cheeks of your bottom together when you sit to avoid pulling painfully on the stitches. Sitting on a pillow may be more comfortable than sitting on a hard surface. Use a squirt bottle with warm water to wash the area with water when you use the toilet; gently pat dry.
“Then you're condemning some women to an episiotomy who might've had a lesser tear or no tear at all if left to their own devices,” she said. Women have the right to refuse any procedure in the hospital, including an episiotomy, but they're not always aware that the doctor is about to perform one.
Exposing the stitches to fresh air can help the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help. It's unusual for pain after an episiotomy to last longer than 2 to 3 weeks.
Pour warm water over the vulva and perineum after going to the toilet. Always pat or wipe from front to back to keep stitches clean. To relieve pressure on the wound, hold a clean pad and press lightly against stitches while going for a poo. Use a stool softener if passing stools (pooing) is particularly painful.
Increased bleeding after your lochia starts to decrease can be a sign you're overdoing it and need more rest. Seeing ongoing clots could mean your uterus is having trouble getting back to its pre-pregnancy size. In either case, it's always best to call.
Modified-median episiotomy
Two transverse incisions are added bilaterally, just above the anal sphincter, extending the median incision. The transverse cuts are perpendicular to the midline, with a total length of 2 to 5 cm.
According to the limited number of studies on sexual function, there seems to be a linear relationship between the degree of perineal laceration and postpartum dyspareunia. It is still not clear whether episiotomy has any impact on pelvic floor relaxation, pelvic organ prolapse, and sexual dysfunction in the long term.
A second-degree tear is deeper. The tear is more than one finger width deep, extending into the muscles of the perineum but does not involve the anal sphincter.
Episiotomy risks
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. A midline episiotomy puts you at risk of fourth-degree vaginal tearing.
Childbirth can stretch and tear the muscles and connective tissues that support the lower organs. Some people heal quickly, but others may need extra help healing and strengthening pelvic floor muscles.
The new tissue may look red and may bleed a little. 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.