If you’re nearing your baby’s arrival or have recently given birth, chances are tearing and episiotomies are on your mind. Episiotomy recovery and healing is probably at the forefront of your mind if you have recently had an episiotomy.

Many women hope to avoid an episiotomy, and many also hope to avoid natural tears.

While episiotomies used to be commonplace, we now know that in many instances, episiotomies aren’t needed.

That said, sometimes there are situations in which an episiotomy becomes necessary.

Read more about when episiotomies are necessary in BellyBelly’s article, When Is An Episiotomy (Cut To The Perineum) Necessary?

Episiotomy Recovery and Healing

Before we jump into the recovery and healing advice, firstly, let’s find out a bit more about the differences between tearing and an episiotomy.

Episiotomy vs. Tearing – Which Is Better?

If you’ve not given birth yet, it can be helpful to learn about all of your options. While there are a few situations where an episiotomy becomes a necessity, current evidence shows that natural tearing is often better in terms of severity, healing, infection, and risk factors.

While routine episiotomy is no longer recommended, it does seem that some tearing can be seen as a normal part of the birthing process. The majority of women do experience some minor tearing, but minor tearing often heals quite quickly, without lasting effects and may not require any stitches.

If baby is experiencing true fetal distress during the second stage of labour (pushing phase), and you’re at risk for tearing towards the urethra (rather than the perineum), or an instrument assisted birth is required, an episiotomy might be necessary.

In those situations, the benefit of an episiotomy outweighs the risks which can include severe tearing, muscle and nerve damage and prolonged healing.

A natural tear, while it has risks, is often mild. Occasionally, it is more severe and requires many stitches, and it can include some of the same risks as an episiotomy. Generally speaking, a natural tear is best, but every birth has a unique set of circumstances.

You can read more in BellyBelly’s article, Episiotomy vs Tearing – Which One Is Better?

Episiotomy Recovery Tips and Advice

If you’ve had an episiotomy, or you want to prepare just in case, here are 5 things you need to know about recovery and healing:

#1: Episiotomy Healing

When an episiotomy or natural tear occurs, it’s important to allow yourself plenty of time to heal. There are many things you can do to help facilitate healing, especially when an episiotomy requires many stitches.

Rest is quite important. In addition to rest the following things can help with healing:

Witch hazel – pads, wipes or simply dab some on several times per day
Warm sitz bath – this can be anything from warm water to warm water with healing herbs
Ice packs/cool compress – the cold can be soothing as well as aid in reducing swelling
Use a peri-bottle – avoid wiping harshly. A peri-bottle can be used to cleanse the area after urination or a bowel movement and then you can gently dap with toilet paper.
Poop carefully – you might think that once baby’s born you’ll be relieved of constantly thinking about your bowel habits (yay for no more pregnancy constipation!). Unfortunately, post birth constipation and pressure on a swollen perineum can be quite unpleasant. Be sure to consume lots of fiber, stay well hydrated, and if prescribed utilize stool softeners.
Be gentle with stitches – follow any instructions your midwife or doctor gives regarding care for stitches.

You can read more about healing in BellyBelly’s article 6 Ways To Heal Your Perineum After Giving Birth.

#2: Episiotomy Complications

The reason routine episiotomy is no longer recommended is there are potential risks involved. While tearing can have risks, episiotomy risks can occasionally be more severe and longer lasting.

Some episiotomy complications include:

Infection – while possible with tearing too, the risk is increased as the cut is often deeper and exposes more tissue. If you have any signs of infection, be sure to contact your midwife or doctor for treatment.
Swelling and irritation – whether you tear, have an episiotomy or remain fully intact, some swelling does occur. However, due to the deeper cut and stitching, swelling with an episiotomy can be quite rough. Icing, witch hazel and resting in a way which keeps pressure off of your perineum can aid in reducing swelling.
Severe bleeding – during an episiotomy there can be a good bit of blood loss if the cut is deep. You can also experience blood loss in the postnatal period if activity or movement reopens the incision.
Muscle or nerve damage – If you experience muscle or nerve damage it may eventually heal on its own with rest. However, sometimes physiotherapy with a pelvic specialist can be necessary for healing
Painful intercourse – postnatal intercourse can be quite uncomfortable for some women in the early months. However, for some women, the painful intercourse persists beyond normal healing time, and it’s more common in those that have had an episiotomy. An osteopath, physiotherapist or pelvic specialist can often help to heal any damage which causes painful intercourse.

#3: Episiotomy Stitches

While some natural tears are mild and do not require stitches, an episiotomy is a surgical incision and due to the depth, requires stitches for healing. Most midwives/doctors will use dissolvable stiches which will eventually come out as you heal. Depending on the severity, you’ll likely be checked at discharge, at your one and at your six week follow ups.

Occasionally, stitches will come out prematurely. If that occurs, your midwife or doctor may need to re-stitch the incision depending on how things have healed.

#4: Episiotomy Care

In general, episiotomy care is similar to general postnatal rest with just a bit of extra attention to your perineum. As you saw above, there are many things you can do to help facilitate healing.

You’ll want to be gentle with stitches by avoiding pressure, over activity, harsh wiping or strenuous bowel movements. You will also need to abstain from sex until your midwife or doctor gives you the okay.

It is also important to keep any eye out for any signs of infection and report them to your healthcare provider if anything does show up. Sitz baths and frequently changing your pads can also ensure good hygiene to help prevent infection.

#5: Episiotomy Scar

Every body is quite unique in how it heals. Some people are prone to thicker scar tissue, while others don’t scar very much. With an episiotomy, due to the depth and stitches, you’re very likely to have at least some scarring. Some will experience pretty deep scar tissue as well.

In the absence of nerve and muscle damage, many don’t find the scar tissue to bothersome. Occasionally, however, dense scar tissue can cause prolonged pain, pain with intercourse and even painful bowel movements. If you’re prone to or end up experiencing deep scar tissue, it’s important to be in contact with your midwife or doctor to aid in healing.

Many options exist to help aid in healing including topical oils or ointments, physiotherapy with a pelvic specialist, and in extreme cases, another surgical procedure.

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Many aspects of birth are wonderful and beautiful. But for some mothers, birth may be more accurately described as a beautiful mess. Lots of joy, lots of beauty, lots of wonder… but sometimes it also includes unpleasant interventions, discomfort and requires time to heal. But thankfully, your episiotomy recovery should be over before you know it.

If you’ve experienced an episiotomy, while it might have some unpleasant aspects, take time to focus on healing and rest. This can help you have a more pleasant postnatal experience while also aiding in healing your perineum.

Recommended Reading: The Undervalued, Therapeutic Power Of Postpartum Rest.