Episiotomy is what many women fear at the moment of childbirth. We often hear a lot about this surgical procedure—so much so that it is frequently dreaded. However, episiotomy , when performed, can help prevent significant complications. In France, it has become less and less common in recent years. In this article, we tell you everything about episiotomy, how to overcome your apprehension, and how to care for the incision if you go through it.

What is an episiotomy?

An episiotomy is a surgical procedure that raises its own set of questions. It is at the origin of many controversies and misunderstandings . We will help you better understand this practice, which occurs in about one in five births in France.

What does an episiotomy involve?

The episiotomy is an incision made on the perineum at the moment the baby's head emerges during the l’ childbirth . It is performed at a 45° angle from the vagina to prevent tearing toward the anus. Here is a very basic definition of this procedure.

Regarding pain, if you opt for a , you will not feel the incision. However, if you prefer a so-called "natural" birth, the medical team can administer local anesthesia. The tissues are very relaxed when the baby passes through, so the pain is less intense. Anesthesia is always used during suturing. It works within a few seconds.

The episiotomy is more common during a first pregnancy , rarer during the second, and even more so in subsequent births. Additionally, if the delivery occurs without epidural anesthesia, the use of instruments (vacuum or forceps) is less frequent. This also results in a decreased rate of episiotomies.

The episiotomy (by its nickname) is not mandatory, just so you know. You can absolutely refuse it. Feel free to discuss it with your midwife and to include it in . Nowadays, doctors try to avoid it as much as possible. Some doctors, like Dr. Riethmuller at the Grenoble University Hospital, have developed techniques that significantly reduce the number of episiotomies.

When is an episiotomy performed?

There are two main reasons why an episiotomy is performed:

• Avoid complete tearing toward the anus: it is rare, but it can happen. Even if you do experience a complete tear, reconstruction is very effective. However, it is always better to avoid it.

• If baby has difficulty during labor : it is even rarer, but an episiotomy can facilitate the birth.

The baby's weight is not related to the practice of an episiotomy. If your baby has difficulty coming out, instruments (vacuum or forceps) or a cesarean section will be preferred by the medical team.

Regarding the perineum, studies do not all agree. Some claim that episiotomy protects it, while others do not. That is why doctors recommend performing episiotomy as rarely as possible , only when it is essential.

Can an episiotomy be avoided?

The episiotomy is a surgical procedure that was, for a time, performed almost systematically. Today, French doctors are trying to perform it less and less. It is still carried out in nearly 20% of deliveries. The doctors prefer a tear to making an incision, because healing is much better and pain is significantly reduced.

To improve your chances of avoiding an episiotomy, it is recommended to perform perineal massage during the 3rd trimester of your pregnancy. Ask your midwife or your gynecologist, who will explain the proper techniques for this delicate area. To do this, you can use the , which will be gentle and respectful of your perineum. This method, in addition to reducing the risk of episiotomy, also decreases postpartum perineal pain and incontinence.

We want to draw your attention to certain techniques that can be dangerous for you. Notably, the Epi-no method, which involves inflating a small balloon inside the vagina. It is gradually inflated a little more each day, and the woman must try to expel it. According to the National College of French Gynecologists and Obstetricians (the CNGOF), this method is not very effective and can have significant long-term negative effects. As always, we can only advise you to discuss it with the healthcare professionals who are monitoring your pregnancy. Communication is always key.

How to promote the healing of an episiotomy?

After everything your body has been through during pregnancy and childbirth, you may feel some discomfort for a few more days. It is certainly not the most pleasant part of recovery, but it is only temporary.

A relatively short healing process

When discussing episiotomy, you might imagine a long and painful recovery. You may experience some discomfort, but most of the time, healing is quick . Additionally, the sutures dissolve on their own as healing progresses.

Usually, within a few days, the pain should disappear. Remember to show your scar to the midwife visiting you at home a few days after your delivery—especially if you are experiencing significant pain. Then, in about three weeks, you should no longer feel any discomfort. If you still do, seek advice from a healthcare professional. During the postpartum check-up, that is, six weeks after the birth of your little adventurer, healing should be nearly complete. It can’t be said often enough: if in doubt, discuss it with your doctor, midwife, or gynecologist—they are there for that.

Episiotomy and postpartum

There are two topics that often raise questions after childbirth, especially after an episiotomy: when you can resume sexual activity and when you can return to sports.

Regarding sexual relations with your partner, it is generally necessary to wait for complete healing , or about two to three weeks postpartum. Your first postpartum weeks will also be accompanied by the lochies , the bleeding and discharges that follow childbirth. So, it is essential to listen to yourself. Be patient with yourself, and resume sexual activity when you truly want to. These moments are best shared together, with mutual consent. ;)

For sports, it is generally recommended to wait for the green light from the healthcare professional who is monitoring your postpartum follow-up. In fact, this usually coincides with the postpartum check-up visit. When we talk about sports, we mean rather intense physical activity. However, we advise you to start your pelvic floor rehabilitation as quickly as possible . You can also engage in low-intensity physical activity, such as walking with your baby—or on your own, for that matter. Getting some fresh air is good for your morale.

What care should be given to the scar?

When you think of an episiotomy or tearing, you may imagine the worst. Even if the pain can be more or less intense, it usually lasts only a few days, and complete healing takes a few weeks. Some tips can help you get through this period more calmly.

The first days

The first days after an episiotomy are the most uncomfortable. If it lasts longer, do not delay—seek medical advice. To relieve the pain, mild analgesics will probably be prescribed for you. You can also use cold to soothe the pulling sensations. Cold compresses or a bag of frozen peas (don’t eat them afterward, or you’ll regret it) wrapped in a towel are very effective.

There are cushions designed for comfortable sitting after an episiotomy; they are available by prescription, so talk to your healthcare professional. Scars do not tolerate moisture well, so we recommend gently patting the area dry. This will support the healing process. It is also advised to wait until complete healing before taking a bath.

The following weeks

After two or three weeks, the suture should start to heal well. After six weeks and your postpartum visit, healing should be complete . The pain is no longer present, so analgesics and cold are no longer necessary, just like the pillow. However, continue to carefully dry the scar, as this supports complete healing. There is no special care needed for an episiotomy scar. If you have any doubts, consult your gynecologist or midwife.

The episiotomy is obviously not a very pleasant moment, but it can help prevent more troublesome consequences . When you are well informed and prepared for this possibility, you will feel more relaxed. As always, communication with the doctors monitoring your pregnancy is essential. And in the end, the joy of welcoming your little one helps you get through it all.