When is an episiotomy performed?

During vaginal delivery, when the doctor finds that labor is getting complicated and the child is struggling to come out, he may decide to perform a episiotomy. This surgical procedure often frightens future mothers, who are afraid of scarring and pain after childbirth. However, this practice is not systematic, it is carried out in very specific cases. How is an episiotomy performed? What are the consequences, and how long does it take to heal? Dr Thierry Harvey, medical gynecologist in Paris, and Pr Philippe Deruelle of gynecology and obstetrics at the University Hospitals of Strasbourg enlighten us.

What is an episiotomy?

At the time of delivery, the obstetrician or the midwife can, when necessary, make the decision to perform an episiotomy to facilitate the delivery of the baby. For this, a small incision of 3 to 4 cm is made at the level of the vulva on the vaginal wall and on the muscles of the perineum. “Episiotomy occurs during the final phase of childbirth: it is performed when the head (or the buttocks if the baby is in a seat) is on the perineum“explains Thierry Harvey.

“Episiotomy occurs during the final phase of childbirth, when the baby’s head or seat is on the perineum.”

When is an episiotomy performed during childbirth?

An episiotomy is “carried out only when absolutely necessary”, specifies Philippe Deruelle. In certain specific cases, the health professional in charge of the delivery takes the decision to use it or not, in view of the visual findings, in particular if:

• The perineum is very distended
• The perineum cannot be crossed, despite good efforts of expulsion
• There is a risk of tears very complex
• Baby’s head stuck
• There is an urgency to get baby out (fetal heart rhythm abnormalitiesrisk of acidosis, etc.)

The doctor or midwife usually performs the episiotomy in the birth room. To make the incision, he uses a scalpel or some surgical scissors. The tool is introduced into the vagina and allows for a so-called episiotomy “45° medio-lateral” : we section the transverse muscle of the perineum, initially median on 2 to 3 cm, then lateral towards the right or left side, and this, to avoid reaching the sphincter of the anus.

Immediately after birth, the obstetrician or midwife suture the incision with absorbable stitches and sutures. This is done under the effect of an epidural, or with the help of local anesthesia. The threads come off naturally after about two weeks.

Is the episiotomy painful?

In principle, episiotomy is painless thanks to the action of epidural anesthesia, or even local anesthesia if necessary. In addition, it is always practiced during a push, so when the perineum whitens and it is almost no longer innervated. However, it is at the time of episiotomy healing that one can feel pains.

What are the consequences after an episiotomy?

After an episiotomy, it happens that the young mother is affected by certain disadvantages such as:

• Painful scarring, especially if the suture has been very tight.
• A puffy scar
• Perineal tears
• An infection
• Painful sex
• Pain to urinate and make excrement, if there has been an attack of the anal sphincter.

Signs of infection following an episiotomy

An infection following an episiotomy is noticed if the pain is not relieved after taking medication if the woman has a fever, if the scar has a bad smell, is swollen or purulent. These signs of infection should lead the young mother to consult a doctor quickly.

How long does it take to heal after episiotomy?

After giving birth, young mothers must be given time to heal. Generally, episiotomy healing lasts 4 weeks and the threads resolve on their own around the 15th day after the baby is born.

Is episiotomy mandatory during childbirth?

In the eyes of the law, episiotomy is not mandatory. Legally, according to Kouchner law of March 4, 2002, the patient always has the possibility of refusing a medical procedure. This law states that“no medical act or treatment may be performed without the free and informed consent of the person and this consent may be withdrawn at any time.”

Ideally, “agreement or refusal to do an episiotomy should be discussed before delivery – when preparing for the birth or during prenatal consultations – and that this is included in the birth plan“, specifies Philippe Deruelle.

To reassure you, know that you are able to ask the rate of episiotomies practiced by the establishment and of course all the indications on this surgical act. Because yes, “it is often the lack of information about episiotomy that scares women the most“, he nuances. Remember that the use of episiotomy has been declining for several years. It fell from 20.1% in 2016 to 8.3% in 2021, according to figures from the 2021 national perinatal survey.

Thanks to Thierry Harvey, medical gynecologist in Paris, and Pr Philippe Deruelle in gynecology-obstetrics at the University Hospitals of Strasbourg.