Episiotomy During Childbirth: What to Expect and How to Heal Fast

As an expecting mother, it is completely normal to feel a mix of excitement and nervous butterflies as your due date approaches. Hearing medical terms like vaginal cutting or stitches can spark anxiety, but knowing the facts can bring immense peace of mind.

When you understand what an episiotomy is, when doctors recommend it, and how to care for yourself afterward, that fear turns into confidence. Let us walk through everything you need to know about this common childbirth procedure in clear, simple terms.

What Is an Episiotomy?

Simply put, an episiotomy is a small surgical cut made by your doctor during childbirth to make delivery easier. The cut is made in the perineum, which is the muscle and skin area located right between your vaginal opening and your back passage.

This incision gently widens the vaginal opening so your baby can pass through more easily and safely. However, doctors do not perform this procedure on every mother anymore.

Sometimes, without any cutting at all, the perineum stretches naturally as your baby crowns and gently tears on its own. Doctors call this natural occurrence a perineal tear or laceration.

In the past, doctors routinely cut everyone believing it healed cleaner and faster. Today, medical guidelines recommend avoiding routine cuts and letting nature take its course whenever it is safe for both mother and baby.

When Is an Episiotomy Necessary?

Even though doctors do not perform episiotomies as often as they used to, certain emergency situations make the cut necessary to protect you and your baby. Your doctor will only make this choice if it is the safest option available.

Here are some common situations where an episiotomy might be necessary:

• Baby is in distress: If your baby's heartbeat drops suddenly, medical staff need to deliver your baby as quickly as possible.
• You are too exhausted: After hours of pushing, you might feel completely worn out and lack the energy to push your baby out safely.
• Assisted delivery tools are needed: If your doctor needs to use special tools like forceps or a vacuum to help guide your baby out, an episiotomy provides extra room.
• Baby is in an unusual position: If your baby arrives bottom-first in a breech position or gets their shoulders stuck, an extra pathway may be needed.
• Baby is very large: When a baby is larger than average, the birth canal may need extra assistance to prevent severe tearing.
• Loss of pushing control: If you push too fast and uncontrollably, a controlled small cut can prevent severe, jagged tearing.
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Why Natural Tears Are Often Preferred Over Cuts
In earlier decades, medical professionals believed that a surgical cut healed much better and prevented severe tearing. They also thought it helped protect against later issues like urinary incontinence.
However, modern medical research shows that episiotomy cuts can sometimes tear much deeper than expected. Natural tears often stop at a minor level with less overall tissue damage.
Because of this evidence, modern doctors encourage natural delivery processes whenever possible and only use surgical cuts when absolutely required.
How the Episiotomy Procedure Works
Doctors perform this procedure during the second stage of labor when your baby's head begins crowning at the vaginal opening.
1. Numbing the area: First, your care team ensures you feel no pain. If you already have an epidural pain block for labor, your lower body is already numb. If not, your doctor injects a local numbing medicine directly into the perineum.
2. Making the cut: Just as your baby's head presses firmly against the perineum, the doctor uses specialized medical scissors to make a quick, clean cut.
3. Delivering baby and placenta: After the cut, your baby is safely delivered, followed shortly by the placenta.
4. Stitching the wound: Finally, your doctor uses dissolvable threads to close the incision carefully. They inspect the tissue to ensure no other complications exist.
Types of Episiotomy Cuts
There are two main types of cuts that doctors can perform during childbirth.
Cut Type	Description
Median (Midline) Cut	This is a straight vertical cut running downward from the bottom of the vaginal opening toward the back passage. It is easy to stitch, but carries a higher risk of extending toward the anal sphincter.
Mediolateral Cut	This cut is angled outward at about a 45-degree angle. It drastically lowers the risk of injuring the anal sphincter, though it takes slightly longer to heal and can be more tender.
What Do Tear and Cut Degrees Mean?
Whether you experience a natural tear or a surgical episiotomy, doctors classify the injury severity into four distinct degrees:
• First-degree: A minor tear affecting only the thin top layer of skin around the vagina.
• Second-degree: A tear extending deeper into the underlying muscles beneath the skin. Most routine episiotomies fall into this category.
• Third-degree: A tear extending through the vaginal tissue and muscles all the way to the ring of muscle that surrounds the anus.
• Fourth-degree: The most severe level, where the tear goes through the anal muscle and reaches into the inner lining of the rectum.
How Painful Is an Episiotomy?
You do not need to worry about the pain of the cut itself. You will feel absolutely zero pain while the doctor makes the incision because the area is fully numbed by your epidural or local anesthetic.
However, once the numbing medicine wears off over the next few days, you will feel soreness, tenderness, and discomfort when walking or sitting down.
Risks and Complications of Episiotomies
Like any medical procedure, an episiotomy carries some potential risks. Keep in mind that some of these risks can happen even with natural tears.
• Bleeding from the surgical site .
• Infection in the stitches or wound .
• Painful intercourse during recovery, known as dyspareunia .
• Accidental injury to anal sphincter muscles .
• Scar tissue formation .
• Temporary bladder control issues .
• Longer healing times .
How to Care for Your Stitches at Home
Having soreness and discomfort for a few weeks after getting stitches is completely normal. You can follow these simple steps at home to soothe the area and speed up your healing process:
• Apply ice packs: Place ice cubes wrapped in a clean cloth against your stitches for 10 to 15 minutes to reduce swelling and ease pain. Repeat this several times a day.
• Take a sitz bath: Fill a clean basin with warm water and sit in it for 15 to 20 minutes. This relieves pain, boosts blood flow, and helps your wound heal faster. Try doing this two or three times daily.
• Use a peri bottle: Your hospital will likely provide a peri bottle. Fill it with warm water and gently rinse the stitched area after every bathroom visit to keep the area clean and stop stinging.
• Take pain medicine: Take safe pain relievers like paracetamol as recommended by your doctor to keep your comfort levels manageable.
• Sit on a donut cushion: Sitting directly on hard surfaces puts pressure on your stitches and worsens pain. A ring-shaped pillow relieves that direct pressure.
• Stay clean and dry: Change your sanitary pads often throughout the day and keep your postpartum underwear clean and breathable.
When Can You Resume Sexual Intercourse?
Your body typically needs about six weeks to heal properly. When you attend your postpartum checkup at six weeks, ask your doctor for clearance before resuming sexual intercourse.
Mild discomfort or dryness is common during the first few months. Using a water-based lubricant can make intimacy much more comfortable and enjoyable.
When to Call the Doctor Right away
If you have an episiotomy or stitches, seek medical help right away if you notice any of the following warning signs:
• Pain that gets progressively worse instead of better each day.
• Foul-smelling discharge, pus, or fluid leaking from the stitches.
• Skin around the cut that looks bright red, hot, or severely swollen.
• Heavy bleeding or blood clots coming from the wound.
• Fever, chills, body aches, or flu-like symptoms.
• Severe or worsening pelvic pressure.
Sources & References:
• American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin: Episiotomy Guidelines.
• National Health Service (NHS UK). Episiotomy and Perineal Tears Recovery Guide.
• Mayo Clinic. Episiotomy: When it's needed and how to recover.
• Centers for Disease Control and Prevention (CDC). Maternal Health and Postpartum Care.
• World Health Organization (WHO). Recommendations on Intrapartum Care for a Positive Childbirth Experience.