Labor and delivery (18)
- Episiotomy: When it's needed, when it's not
- Signs of labor: Know what to expect
- Water breaking: Understand this sign of labor
- see all in Labor and delivery
Postpartum care (14)
- Exercise after pregnancy: How to get started
- Maternity leave: Tips for returning to work
- C-section recovery: What to expect
- see all in Postpartum care
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Episiotomy: When it's needed, when it's not
The role of warm compresses and tissue massage
During the second stage of labor — when you're pushing — your health care provider might apply warm compresses to the tissue between your vaginal opening and your anus. This might soften the tissue and help prevent tears in the skin.
Although the evidence for warm compresses is stronger, some health care providers also massage the area between the vaginal opening and the anus as labor progresses. This is known as perineal massage.
Your health care provider might even recommend trying perineal massage at home before delivery — although you don't have to do it if the idea makes you uncomfortable.
Start by washing your hands thoroughly with soap and hot water. Make sure your nails are trimmed. Then rub a mild lubricant, such as K-Y jelly, on your thumbs. Place your thumbs just inside your vagina and press downward toward your rectum. Hold for one to two minutes. Then, slowly massage the lower half of your vagina. Repeat the massage once a day for 10 minutes at a time until delivery.
Healing from an episiotomy
If you have an episiotomy or tear during delivery, the wound might hurt for a few weeks — especially when you walk or sit. If the incision or tear is extensive, the tenderness might last longer. Any stitches used to repair the episiotomy will usually be absorbed on their own.
In the meantime, you can help promote healing:
- Soothe the wound. Apply an ice pack to the affected area, or place a chilled witch hazel pad between a sanitary napkin and the wound. You can find witch hazel pads in most pharmacies.
- Take the sting out of urination. Use a plastic cup to pour warm water over your vulva as you're urinating, and rinse yourself with a squirt bottle afterward.
- Prevent pain and stretching during bowel movements. Press a clean pad firmly against the wound when you bear down for a bowel movement.
- Sit down carefully. Tighten your buttocks as you lower yourself to a seated position. Sit on a pillow or padded ring rather than a hard surface.
- Use medication as needed. Your health care provider might order prescription medications or recommend an over-the-counter pain reliever or stool softener. Pain-relieving creams or ointments haven't been found to be effective for episiotomy wounds.
- Consider complementary treatments. Some research suggests that lavender might help relieve pain after a tear or episiotomy. If your health care provider approves, add a few drops of lavender essential oil to your bath water or apply the oil directly to the tissue between your vaginal opening and your anus.
While you're healing, expect the discomfort to progressively improve. Contact your health care provider if the pain intensifies, you develop a fever or the wound produces a pus-like discharge. These could be signs of an infection.
Accept some uncertainty
Share your thoughts about episiotomy with your health care provider during your prenatal visits and again when labor begins. Remember, though, it's important to go into labor with an open mind. It'll take time for the baby to stretch the vaginal tissues to allow delivery, and sometimes the baby needs to be delivered before the vaginal tissues can stretch on their own.
Count on your health care provider to respect your wishes about episiotomy — and to let you know when it's the safest option for you or your baby.
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- Robinson JN. Approach to episiotomy. http://www.uptodate.com/index. Accessed May 2, 2012.
- Toglia MR. Repair of episiotomy and perineal lacerations associated with childbirth. http://www.uptodate.com/index. Accessed May 2, 2012.
- Bharucha AE, et al. Obstetric trauma, pelvic floor injury and fecal incontinence: A population-based case-control study. The American Journal of Gastroenterology. In press. Accessed May 2, 2012.
- Sheikhan F, et al. Episiotomy pain relief: Use of lavender oil essence in primiparous Iranian women. Complementary Therapies in Clinical Practice. 2012;18:66.
- Lavender. Natural Medicines Comprehensive Database. http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=MAYO&s=ND&pt=100&id=838&ds=&name=LAVENDER&lang=0&searchid=34422770. Accessed May 2, 2012.
- Aasheim V, et al. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews. http://summaries.cochrane.org/CD006672/perineal-techniques-during-the-second-stage-of-labour-for-reducing-perineal-trauma. Accessed May 2, 2012.
- Dame J, et al. Clinical inquiries: Does antepartum perineal massage reduce intrapartum lacerations? The Journal of Family Practice. 2008;57:480.
- Lowdermilk DL, et al. Maternity & Women's Health Care. 10th ed. St. Louis, Mo.: Elsevier Mosby; 2012:470.
- You and Your Baby: Prenatal Care, Labor and Delivery, and Postpartum Care. Washington, D.C.: The American College of Obstetricians and Gynecologists; 2011:35.
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