Episiotomy: What is it, How is it Done, and Recovery

Episiotomy is a surgical procedure that is used to enlarge the vaginal opening during childbirth. This can help ease the baby’s passage out of the birth canal.

Episiotomy is generally performed when there is concern that the baby may become stuck in the birth canal or if there is excessive tearing of the tissues around the vagina. In this blog post, we will discuss what an episiotomy is, how it is done, and what to expect during recovery.

What is an episiotomy?

An episiotomy is a surgical incision made in the perineum and the posterior vaginal wall during the second stage of labor. Episiotomies are performed to widen the vaginal opening for delivery or to prevent tissue tearing during childbirth.

Why is it performed?

An episiotomy is generally performed during the second stage of labor when the baby’s head is crowning.

The purpose of the incision is to enlarge the vaginal opening so the baby can be delivered more easily. In some cases, an episiotomy may also be necessary to prevent the baby’s head from being pushed back up into the mother’s pelvis during delivery.

Types of episiotomy

There are four types of episiotomy:

  • Median incision: This is a cut made in the middle of the perineum (the area between the vagina and the anus).
  • Mediolateral incision: This is a cut made at an angle from the middle of the perineum towards the side (either left or right).
  • Lateral incision: This is a cut that extends laterally. It is condemned due to the chance of injury to the Bartholin’s duct.
  • ‘J’ shaped: This is a cut made in the shape of the letter ‘J’ and is used in cases where there is already an incision (episiotomy or laceration) present.

How is an episiotomy performed?

Steps of mediolateral episiotomy

Step-1: Preliminaries

The perineum is swabbed with an antiseptic solution and draped. A local anesthetic is infiltrated into the perineal skin and subcutaneous tissue.

The patient is positioned in the lithotomy position with her buttocks at the edge of the delivery table and her legs in stirrups.

Step-2: Incision

Two fingers are placed in the vagina between the presenting part and the posterior vaginal wall. A scalpel or scissor is inserted at a 45-degree angle from the midline towards the side and parallel to the long axis of the vagina.

The incision is extended laterally for about 2.5 centimeters away from the anus.

Step-3: Repair

The baby is delivered, and the episiotomy is repaired by sutures.

Post-operative care

  • Dressing: The wound is to be dressed each time after urination and defecation to keep the area clean and dry.
  • Analgesics: Painkillers are to be taken as per the doctor’s prescription.
  • Ice packs: A perineal pad is placed over the episiotomy wound and held in place with gauze. Ice packs are to be applied to the wound for 20 minutes each hour.
  • Rest: Bed rest is recommended for the first 24 hours after an episiotomy.
  • Stool softener: A stool softener is to be taken to avoid constipation and straining during bowel movements.
  • Kegel’s exercises: Kegel’s exercises are to be done to strengthen the pelvic floor muscles.
  • Removal of stitches: The stitches are to be removed within five to seven days after an episiotomy if non-absorbable material was used. Sutures do not need to be removed in case of absorbable sutures, as they will be absorbed.

What are the risks of episiotomy?

The risks of episiotomy include:

  • Bleeding
  • Pain
  • Infection
  • Reduced sexual satisfaction
  • Extension of the incision to involve the rectum
  • Dyspareunia (difficult or painful sexual intercourse)
  • Perineal lacerations

How long does it take to recover from an episiotomy?

It takes about 4-5 weeks for the incision to heal. During this time, it is important to keep the area clean and dry. You may also need to take pain medication and use a perineal pad or sitz bath to help with healing.

After the incision has healed, you may notice some changes in your sexual function. These changes are usually temporary and will resolve over time. In some cases, however, the changes may be permanent. If you have any concerns, talk to your doctor or midwife.


Most women heal well after an episiotomy. Recovery times vary but are typically between two to six weeks.

During this time, it is important to avoid constipation and straining when going to the bathroom to heal your episiotomy wound faster. This can be done by eating a high-fiber diet, drinking plenty of fluids, and taking stool softeners as needed.

Women should also avoid sexual activity and using tampons until the episiotomy has healed. If you have any questions or concerns about your recovery, be sure to talk to your doctor or midwife.

If you experience heavy vaginal bleeding, severe pain, pus discharge from the wound, or fever, consult your health care provider right away.

That’s all for now! I hope this post helped understand what an episiotomy is and how it is performed. If you have any questions, please feel free to leave them in the comments below.

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