An episiotomy is a surgical procedure where a small incision is made between the vagina and the anus to widen the vaginal opening during childbirth. Although the procedure is not used as often as it once was, an episiotomy is still sometimes performed if the mother or baby is in distress. 

Why is an Episiotomy Performed? 

Traditionally, an episiotomy was performed to prevent complications that could arise from severe tearing of the perineum. The perineum is the area between the anus and the vagina and its main role is to protect the bowel, urinary tract, and pelvic floor muscles, as well as the nerves and blood vessels connected to the genitals. 

Although many women experience natural perineal tears during childbirth, it was once believed that performing an episiotomy could prevent the tear from extending through the sphincter muscles and into the rectal lining. 

So when the perineal muscles and skin were stretched to their limit during the latter stages of childbirth, an obstetrician or midwife might perform an episiotomy under anesthesia to prevent the perineum from tearing too severely as the baby’s head passed through the vaginal opening. 

Recent research has shown, however, that an episiotomy does not necessarily prevent the foreseen complications and it may instead encourage natural perineal tearing to extend further. Due to this recent research, obstetricians currently perform an episiotomy only when either the mother or the baby is in distress. 

Situations where an episiotomy might be necessary include the following:

  • When the baby is in distress and a quick delivery is required
  • When the baby is in breech or its shoulders are stuck in the pelvis
  • When the baby or the baby’s head is too big for a fully stretched vaginal opening
  • When the mother is too exhausted to push any more
  • When the mother can’t control her pushing 
  • When forceps or a vacuum is required to deliver the baby, the vaginal opening may need to be widened
  • When the baby’s birth is imminent and the perineum has not stretched sufficiently 

What Are the Advantages of An Episiotomy? 

Since an episiotomy is no longer a routine part of childbirth and is performed only when necessary, the advantages of the procedure include a safe delivery for both the mother and baby. An obstetrician might also perform an episiotomy to prevent what they foresee as severe tearing that could cause future complications for the mother.  

Possible Complications of An Episiotomy

The complications that can occur when an episiotomy is performed vary from a temporary infection of the wound to a long-term injury of the rectum and sphincter. Sutures will be used to close an episiotomy incision within an hour of the baby’s delivery and although most heal within a few weeks or months, depending on the severity of the cut, some incisions could take longer.

In addition to infection, complications can arise due to severe bleeding, bruising, or swelling. Painful sex (dyspareunia) can also occur after healing due to the growth of scar tissue around the incision. For some women, urinary or bowel incontinence can linger long after they’ve recovered from the birth. And if the pelvic floor muscles don’t sufficiently recover, pelvic organ prolapse can occur. 

It’s important to note that each of the complications mentioned above can also occur when a natural perineal tear is sutured after childbirth.   

Can Perineal Tearing or an Episiotomy Be Prevented? 

Although perineal tearing is generally out of the mother’s control, some useful tips and lifestyle changes can reduce the risk of tearing and the need for an episiotomy. 

Preparing the vaginal and perineal muscles to stretch is one of the best ways to prevent tearing during childbirth. Typically recommended from week 36, massaging the soft tissue of the perineum is believed to reduce tearing by up to 24%. Although perineal massage can be done with the hands, the pelvic massage wand from Intimate Rose with 10 vibration speeds is enormously helpful in this respect. 

A pelvic massage wand, as we’ll outline below, can also be used for postpartum recovery of the perineal muscles and tissues.   

Kegel exercises are also helpful to build strength in the pelvic floor muscles. During childbirth, the pelvic floor muscles experience immense strain. While there is no clear research on the effects of having strong muscles on episiotomy outcomes, strength is one of the important overall factors in pelvic health in addition to flexibility, endurance, and tone. 

A balanced diet containing more plant-based food than meat is also helpful to prevent tears during childbirth. Ensuring a daily intake of nutritious and vitamin-rich food can improve skin health and enable it to stretch more easily. 

During labor, not laying on the back while pushing is believed to reduce the risk of perineal tearing as can applying a warm compress to the perineum while pushing.

What Happens After an Episiotomy or Perineal Tear?

When the wound is cleaned and cared for as per the instructions from healthcare providers, most episiotomy incisions and perineal tears will heal within a few months as bleeding, bruising, and swelling subsides. However, to avoid side effects like urinary incontinence, pelvic floor disorders, or painful sex, it’s also important to care for the muscles and scar tissue surrounding the scar. 

When the fibers of scar tissue are forming, they receive less blood and oxygen than normal skin tissue, are usually weak, and have limited movement. As scar tissue continues to form around other tissue in the body, the lack of movement can result in tightness and pain. For similar reasons, the muscles and skin surrounding a recent incision also lack elasticity as they heal. 

Improving the blood flow and muscle elasticity around the incision as well as massaging the forming scar tissue can prevent future tightness and complications including pelvic organ prolapse, pain during sex or while having a bowel movement, and incontinence.   

How to Heal from an Episiotomy or Perineal Tearing During Childbirth

For the first few weeks after an episiotomy or perineal tearing, caring for the wound and keeping it clean is vital to avoid infection. Pelvic health experts recommend applying ice wrapped in a towel against the perineum to reduce bruising and swelling and resting with the feet higher than the heart to improve blood circulation to the perineum. Once new mothers feel up to it, a 5–10-minute walk per day can help improve elasticity in the muscles around the wound. 

As each week passes, gentle activity continued and the daily walking time can be increased by 5-10 minutes with each week. 

After the sixth week, a check-up with a healthcare provider will let new mothers know if the wound has healed sufficiently to begin some perineal massage for 3-5 minutes per day. Although somewhat uncomfortable to begin with, perineal massages will begin to feel less painful as some strength and flexibility are restored to the muscles and skin tissues around the wound.   

After 6-8 weeks, perineal massage should feel less intense and possible for up to 10 minutes per day. At this stage, a pelvic massage wand would be recommended to massage scar tissue on a deeper level for more healing. A set of vaginal dilators are also highly recommended to restore strength and flexibility to the pelvic floor and vaginal muscles. 

Following this method of recovery from a perineal tear or an episiotomy will significantly reduce the risk of the long-term complications mentioned earlier. And using these pelvic health tools as part of recovery will also prevent the raised bumps that can often form around surgical scars. 

Even though pelvic massage wands and vaginal dilators are safe and recommended for use at home, it is advisable to first seek guidance from a gynecologist or pelvic physical therapist to understand how they are used. 


Although an episiotomy was previously a common procedure to prevent severe perineal tearing during childbirth, episiotomies are currently only performed when the mother or baby is experiencing difficulties. Whether recovering from an episiotomy or perineal tearing, the recovery process is vital to avoid long-term complications like incontinence, painful sex, and pelvic organ prolapse.  

Massaging the perineum and ensuing scar tissue with a pelvic massage wand or using vaginal dilators to rebuild pelvic strength and flexibility can significantly reduce the risk of long-term complications. Before beginning, it’s wise to speak with an obstetrician or pelvic physical therapist for guidance and clear instructions.  


The American College of Obstetricians and Gynecologists – What is an Episiotomy?

What To Expect – Vaginal & Perineal Tears During Childbirth -

Female Health Awareness - Understanding the Impact of a Vaginal Delivery on the Pelvic Floor -

Birth Injury Health Center - Episiotomy Complications and Side Effects -

Obstetrics & Gynecology Online Library - Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities -


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