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Is it safe? · Pregnancy Smart

Is episiotomy safe during pregnancy?

Assigned clinical reviewerPerry Friedman· MD, FACOG-MFMDraft · pending clinical reviewUpdated

What does the evidence say about episiotomy during pregnancy?

  1. An episiotomy cuts skin and muscle between the vagina and anus to enlarge the opening during selected births. It requires pain relief and suturing and can extend into a deeper injury. 1
  2. A Cochrane review found that selective rather than routine episiotomy was associated with less severe perineal or vaginal trauma when unassisted vaginal birth was anticipated. The severe-trauma evidence was low certainty and did not settle every assisted-birth situation. 2
  3. A 2024 Cochrane review found moderate-certainty evidence that warm compresses during the second stage probably lower the combined rate of third- or fourth-degree tears. Other outcomes were uncertain or unchanged, so the technique does not guarantee avoiding a tear or incision. 3
  4. Absorbable stitches usually do not need removal. tissue repair can take several weeks, and wound care, comfort measures, bowel care, and return to sexual activity should follow postpartum instructions rather than a fixed recovery promise. 4
  5. Recognized complications include extension of the incision, bleeding, infection, and painful sex. Recovery after a planned cut is not automatically easier than recovery after a spontaneous tear; depth and structures involved matter. 1

Is episiotomy safe in each trimester?

  • First trimester. Discuss preferences about selective episiotomy and informed consent during prenatal care. A birth plan can record these preferences while allowing discussion of an unexpected urgent delivery.
  • Second trimester. Ask the birth team how they approach warm compresses, perineal support, assisted vaginal birth, and the choice of incision. Evidence about uncomplicated vaginal birth does not answer every forceps or vacuum situation.
  • Third trimester. During birth, the clinician weighs fetal status, the need to expedite delivery, and perineal anatomy. After repair, follow the individual wound-care plan and report worsening pain, odor, separation, or bowel-control problems.

Frequently asked questions

Is an episiotomy routine for a first birth?

No. Being a first-time parent does not by itself establish a need for episiotomy. The evidence supports selective use, with a specific explanation of why the clinician believes a cut is useful in the circumstances.

Is an episiotomy better than tearing?

There is no universal ranking. A small spontaneous tear differs from an injury involving the anal sphincter. An episiotomy itself creates a wound and can extend, so the comparison depends on anatomy, birth circumstances, and the proposed incision.

When might an episiotomy be considered?

It may be considered when birth needs to happen quickly because of fetal concerns or during selected assisted vaginal births. Ask what problem it addresses, whether alternatives are feasible, and how pain relief and repair will be handled.

Can warm compresses or massage guarantee avoiding a cut?

No. Some perineal techniques have evidence for specific outcomes, but none guarantees an intact perineum. Ask the birth team which technique fits your circumstances and distinguish measures during labor from antenatal perineal massage.

Do episiotomy stitches need removal?

The repair usually uses stitches that dissolve. Arrange examination if the wound seems to open, discharge smells unpleasant, or pain increases. Do not pull at visible suture material or assume every painful spot is simply a stitch.

What helps during episiotomy recovery?

Use the wound hygiene, pain-relief, cooling, and bowel-care plan supplied by the maternity team. Avoid rubbing the area or straining. Ongoing pain or constipation deserves review rather than adding products to the wound without guidance.

When can I have sex after an episiotomy?

Wait for tissue repair and postpartum clearance, and do not push through pain. A calendar date does not prove the wound or pelvic floor is ready. Persistent scar pain or pain during sex can be assessed and may need pelvic-health support.

When does an episiotomy wound need urgent review?

Contact the maternity team promptly for increasing pain, foul discharge, wound opening, fever, or new bowel-control difficulty. Heavy bleeding, fainting, or feeling acutely unwell needs urgent care. A tissue repair wound should generally become more comfortable over time.

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References

  1. Episiotomy

    MedlinePlus · https://medlineplus.gov/ency/patientinstructions/000482.htm

  2. Selective versus routine use of episiotomy for vaginal birth.

    PubMed · https://pubmed.ncbi.nlm.nih.gov/28176333/

  4. Episiotomy - aftercare

    MedlinePlus · https://medlineplus.gov/ency/patientinstructions/000483.htm

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.