Episiotomy

1 What is an Episiotomy?

An episiotomy is an incision between the vagina and the rectum to increase the size of the opening of the vagina to assist in the delivery of a baby. It is performed in about 40% of vaginal deliveries in the USA but it is less common in Europe.

The incision typically does not involve the muscles around the rectum or the rectum itself. The incision is repaired by suturing (sewing) the wound together straightforward after delivery and it is fairly simple to perform. 

The patient can receive anesthesia in the form of nerve blocks or local injections of anesthetic if she has not received regional anesthesia (such an epidural) for the delivery.

The typical healing time for an episiotomy is around 4 to 6 weeks depending on the size of the incision and the type of suture material used to close the wound.

The advantages of an episiotomy are decreasing the amount of pushing the mother during delivery, decrease trauma to the vaginal tissues and expedite delivery of the baby when delivery is necessary quickly.

The possible complications of an episiotomy are extensions or tears into the muscle of the rectum or even the rectum itself, local pain, bleeding, swelling, a short-term possibility of sexual dysfunction, infection, and defects in wound closure.

The American College of Obstetricians and Gynecologists supports that episiotomy should be considered only in certain situations when there is a high risk of severe lacerations or the need to facilitate rapid delivery of a fetus.

Doctors who prefer episiotomies said that a surgical incision is easier to repair than a spontaneous irregular or extensive tear, and is likely to lead to a more favorable outcome with fewer complications.

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