An episiotomy is the surgical cutting of the perineum, the skin below the vaginal opening, in the course of childbirth. Episiotomy stitches are surgical sutures that close the incision so that it can heal properly. The stitches usually dissolve, and the incision heals within about six weeks. Proper care of the stitches and the surrounding area is necessary to avoid infection or complications.
Some doctors routinely perform episiotomies to prevent tearing of the perineum as a tear is harder to suture than a surgical incision. Not all childbirths require episiotomies. Some of the factors that determine if an episiotomy is performed include the position of the baby during birth, existing scar tissue on the perineum, and previous uterine prolapse. Prior to childbirth, there are things that can be done to limit the need for an episiotomy. Perineum massage will help keep the perineum elastic and able to stretch during childbirth, and Kegel exercises strengthen the perineum muscles.
The procedure takes about 10 to 20 minutes and is usually performed at the point in childbirth when the physician can see the baby’s head. A local anesthetic may be applied to the perineum. The physician then makes a short incision, either straight down toward the anus or at a slight angle. After the birth, the physician cleans the incision and closes it with several episiotomy stitches. The stitches are made of an absorbable material and will not need to be removed later.
Episiotomy stitches and the surrounding skin should be kept clean with warm water and unscented soap. To help with healing, the stitches should be exposed to the air at least a couple of times a day for at about 10 minutes each time. Regular hand washing will help prevent an infection, particularly before touching the area and before using the bathroom. Patients should abstain from intercourse for about eight weeks in order to give the episiotomy incision time to heal completely.
Complications after episiotomies are uncommon. Patients should monitor the stitches until the episiotomy incision is healed. The stitches may cause pain, fall out, or become infected. A patient should notify her doctor if the stitches remain painful after the first week, if they become dislodged or fall out, or if there is an unusual discharge from the stitched skin. The episiotomy stitches may sting during urination, and pouring warm water on the area during and after urination can provide some relief.