Childbirth is a lot of things, but neat and pretty aren't exactly terms that can be used to describe it. Raw, natural, empowering, scary, exciting, awe-inspiring? Sure. But tidy? Definitely not. There are a lot of things that can happen during a vaginal birth, and although doctors and midwifes generally do an amazing job of downplaying it all, the thought of everything that's going on "down there" can get a little bit intense. Being nervous about the thought of needing an episiotomy is normal, but knowing how it's done can ease your mind. How do they do an episiotomy exactly? It's not as scary as it sounds. I had episiotomies during both of my unmedicated vaginal deliveries and both times, I didn't even know it happened.
According to the Mayo Clinic, an episiotomy is an incision in the perineum that is thought to make a difficult labor progress more easily. They can be necessary if an extensive tear is thought to happen, if your baby is in an abnormal position, or if your baby needs to be delivered quickly. The article stated that they used to be very common, however, recently doctors avoid them unless they're absolutely necessary. Because, hey, recovery is difficult enough without added incisions.
However, if you do need an episiotomy, you'll most likely be glad the doctors make the decision when they did. In cases where it's medically necessary to perform one, an episiotomy can speed things along and make your labor much smoother after it's done.
According to Healthline, there are two types of episiotomies: a midline episiotomy and a mediolateral episiotomy. A midline episiotomy is made in the middle of the vaginal opening, straight down towards the anus. These episiotomies are thought the be the easiest to recover from, the least painful, and the simplest to perform.
A mediolateral episiotomy, however, is made in the middle of the vaginal opening and extends at a 45 degree angle towards the buttocks. These episiotomies are thought to increase the risk of blood loss, be more painful, and harder to recover from. Therefore, doctors generally avoid them unless absolutely necessary.
To perform either type of episiotomy, the doctor will first numb the area using anesthesia. Once your baby's head is visible by three or four centimeters, they'll make a small incision, while putting slight pressure on your baby's head to keep it from coming out too quickly.
After delivery, your doctor will clean the incision and carefully examine it to make sure no further damage has been done. Then, they'll repair the incision with sterile surgical thread, that will dissolve on it's own after a few weeks.
Although, Baby Center noted, episiotomies can make your recovery a bit more difficult, if all goes well, it should only take a few weeks for you to feel completely back to normal.