An episiotomy is a straightforward and purposeful surgical procedure carried out during labor. During this procedure, a small incision is made in the perineum—the area of skin and muscle between your vagina and rectum. The goal is to carefully enlarge the vaginal opening to facilitate childbirth. This procedure has been a common practice in many delivery rooms across the globe, though the frequency may differ depending on specific healthcare practices and cultural norms.

Historically, episiotomies have been performed routinely to expedite delivery during the pushing phase of labor, prevent tears to the vagina, and mitigate trauma to both mother and child. Additionally, it was believed that this surgical incision could protect the integrity of the vaginal muscles.

Today, we have evolved our understanding significantly. Physicians worldwide, backed by substantial evidence, now advise that episiotomies should not be performed as a matter of routine. A pivotal study highlighted that while routine episiotomies might decrease tears in the front of the vagina, they increase the risk of tears at the back. Consequently, distinguished organizations, including the World Health Organization, recommend personalized decisions based on specific circumstances. These include:

• Fetal or Maternal Distress: An episiotomy may be necessary to expedite delivery in cases of complications, ensuring the safety of both you and your baby.
• Delivery of a Large Baby: For a large baby, particularly if the head is robust, an episiotomy might facilitate a safe passage.
• Involuntary Pushing: If the perineum hasn't had adequate time to stretch naturally, intervention might be considered.
• Operative Deliveries: The use of tools like forceps or a vacuum may require an episiotomy to optimize outcomes.

Types of Episiotomies: Tailoring to Your Needs

Median Episiotomy: This type of incision is straightforward, extending from the vagina directly towards the anus.

Medio-Lateral Episiotomy:  Here, the cut is made at an angle from the vagina towards the anus. This approach minimizes the risk of tearing to the anus but might require more intricate repair and healing time compared to the median method.

Typically, the incision from an episiotomy is sutured immediately following delivery, with most doctors utilizing stitches that dissolve on their own over time.

Caring for your Episiotomy Post-Delivery

Post-delivery, your focus should be on healing and comfort. Here are scientifically supported methods to aid in your recovery:

• Gently cleanse the area with a squirt bottle filled with warm water instead of physically wiping, reducing irritation.
• Utilize cold packs applied to the perineum to relieve swelling and numbness.
• Consider medicated pads, such as Tucks, to soothe and heal the incision area.
• Engage in Sitz baths, warm water baths designed to cover the buttocks and hips, which expedite healing and alleviate pain.