True-false on episiotomy

Test your knowledge of episiotomy

“Episiotomy corresponds to a surgical act performed during childbirth to avoid large tears in the perineum”, the lower wall of the pelvis, explains Dr Frédéric Sabban, an obstetrician-gynecologist in Paris. This surgical act consists of making an incision of about 4 to 6 cm at the level of the opening of the vagina, vertically or obliquely. In this way, the release of the baby’s head is facilitated during delivery, without uncontrollable tearing taking place. Is it systematic? Should sexual intercourse be avoided during healing? Should we change our hygiene habits? The point with this true / false on the episiotomy.

Episiotomy is performed routinely

False. If it is not systematic, episiotomy would be performed in 20 to 50% of deliveries in France according to Dr Sabban. It is particularly recommended in the case of an extraction of the baby using forceps. According to Dr Sabban, the decision whether or not to proceed with an episiotomy is very “doctor or midwife dependent” and is made at the last moment, when the baby’s head appears. However, you can discuss this beforehand with the medical team who will supervise you, so that everything goes as well as possible during the delivery.

Without an episiotomy, there is sometimes a risk of a tear

True. If an episiotomy is not performed when necessary, there is a risk of ” tear of the sphincter, especially in the anus, which can cause problems with anal incontinence, ”warns the obstetrician-gynecologist. Episiotomy is therefore often offered as a preventive measure to avoid this risk of complications. It is however a controversial subject, because some health professionals stress that episiotomy is performed too systematically.

The suture of the episiotomy is painful

False. After childbirth is finished, the episiotomy is sutured. As with the episiotomy itself, the suture is normally done under epidural anesthesia if the woman has had it, or under local anesthesia if the delivery took place without an epidural. A priori the fact of stitching should not hurt, since the area is asleep.

The suture is done with threads which are usually absorbable and will fall off on their own after a few weeks.

You have to wait before resuming a sex life

True. On the side of sexual intercourse, gynecologists are rather unanimous. They advise against any sexual intercourse before one month to six weeks. “As a general rule, we advise you to wait for the post-natal appointment” planned with the gynecologist or midwife, summarizes Dr. Sabban. Because not only can intercourse be painful before this date, but the scar may reopen and lead to complications. During the post-natal consultation, the doctor or midwife will look at how the scar from the episiotomy has evolved and give or not the “green light” to resume intercourse.

There is no need to pay particular attention to the hygiene of the area

False. Dr Sabban advises to Systematically clean yourself well after going to the toilet for healing time, to avoid any risk of burns or infection. If you notice a smelly or unusually colored vaginal discharge, it is best to consult without delay as this may be a sign of an infection, which will delay healing. Also make sure the scar is always dry by patting it with a clean towel or using a hair dryer.