Episiotomy

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

An episiotomy may only be done with your consent.

This procedure can help reduce your risk of having a severe tear in your vagina or perineum if:

• your baby needs to be born quickly
• you need to have an assisted vaginal delivery

If you have an episiotomy, you may still experience a tear in your vagina or perineum.

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 (when a forceps or vacuum cup are needed to help your baby be born)
• because your baby has become distressed (is showing signs they may not be well) and they need to be born quickly
• because there is a likelihood of a severe perineal tear

An episiotomy is not recommended for every vaginal birth.

An assisted birth may be recommended if:

• your baby is unwell or in distress
• 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

If you don't have an epidural block or your epidural pain relief is not working well, your doctor or midwife will give you an injection of local anaesthetic. This is to numb the skin around your perineal area 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.

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

Perineal massage is usually started at about 35 weeks of pregnancy if you are 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's 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 chance of getting a serious tear.

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.

Your healthcare team will do their best to support your birth preferences. Sometimes unexpected situations happen during labour and childbirth meaning an episiotomy may be recommended. If you don't want to have one, your healthcare team will advise you on the risks and benefits of this.

You will make the final decision about having an episiotomy.

If you have an episiotomy, your doctor or midwife will stitch the cut 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 help reduce swelling and discomfort.

The stitches usually dissolve in 1 to 2 weeks.

It may take up to a month 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 me recover after having an episiotomy?

There are a few things you can do to help your perineal area heal:

• Try to rest as much as possible and lie on your side if you can.
• 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.
• Keep the tear clean and dry by showering daily, and after you open your bowels (do a poo), and gently pat dry.

There are some things you can do to reduce discomfort when using the toilet:

• Try to keep well hydrated so your urine is less concentrated — this can help reduce stinging.
• Take your time when emptying your bladder and bowel and avoid pushing or straining.
• Keep a water jug beside the toilet to poor over the area when urinating.
• Use a foot stool, or lift your heels up so that your knees are above your hips and kept together, when you're sitting on the toilet.
• Try leaning forward on the toilet when you pass urine. This will keep the urine away from the tear and reduce stinging.

There are some things it is best to avoid during recovery:

• 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.
• Avoid using any cream, ointments or powder on the area, unless you've been advised to by your healthcare provider.
• Avoid becoming constipated — drink plenty of water and try to eat a diet rich in fibre (fruit, vegetables and wholegrains).

Keep in mind that everyone's recovery is different. Your doctor and healthcare team should give you instructions to suit your situation.

You can use a mirror to see how well your episiotomy is healing. If you are worried that it's not healing properly, talk to your doctor or midwife.

Once your midwife or doctor confirms that your episiotomy is completely healed, you can massage the scar tissue to help with your recovery. Learn more about scar healing and recovery.

Infections

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

• swelling
• discharge of pus or 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 you with pelvic floor exercises to strengthen your pelvic floor muscles after birth.

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 happen compared 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.

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.

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.

See your doctor if you have other symptoms affecting your vagina, bladder or bowel after birth, including if:

• 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

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.

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

Visit the Birth Trauma Australia 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.

Continence Health Australia offers information and support to people with bowel and bladder problems. You can call the helpline on 1800 33 00 66.

Visit ForWhen: Perinatal Depression & Anxiety Helpline. You can call the helpline on 1300 24 23 22.

Visit Beyond Blue or call 1300 22 4636.