Labour & birth

Does an episiotomy hurt and can it be avoided?

We explore what an episiotomy is, does an episiotomy hurt and can it be avoided?

What is an episiotomy?

An episiotomy is a surgical cut to your perineum, which is the muscular area between your vagina and back passage. This cut helps if there are concerns about you or your baby.

Why might I need to have an episiotomy?

Your midwife or obstetrician should only offer you an episiotomy if she feels that you will benefit from having the procedure. An episiotomy is not a routine part of labour and may cause more harm than good if it’s not necessary.

Saving episiotomy for only when it is really needed means that you will have:

  • Less damage to your perineum
  • A lower risk of needing stitches
  • Fewer problems with healing
  • Even if you have a tear while giving birth, it can be less painful and heal better than a cut.

However, your midwife or doctor may suggest that you have an episiotomy if:

  • Your baby is distressed and needs to be born quickly
  • You’ve been pushing for a long time and need an assisted birth

labour pain

Can an episiotomy be avoided?

When you are in labour, these self-help measures may help you to avoid an episiotomy: 

  • Using relaxation techniques
  • Being in upright positions
  • Lying on your side if you’ve had an epidural

During your pregnancy, go along to all your antenatal classes so you can learn about preventative measures. Perineal massage and good breathing techniques could help you during the pushing stage.

Does an episiotomy hurt?

If you don’t already have an epidural in place, your midwife /doctor will give you a local anaesthetic in your perineum. Having an anaesthetic means you will only feel minimal discomfort. The tissues around the vagina are tightly stretched during the birth, so it’s easy for your midwife/doctor to make the cut.

Your doctor/ midwife will put in stitches after you’ve delivered the placenta. In some hospitals, you may need to be wheeled into the operating theatre where the lighting and facilities are better. If allowed for better pain relief and positioning, the local anaesthetic should mean you should feel no pain at all during stitching. If you feel pain during stitching, tell your midwife/ doctor that you need more pain relief immediately.

Recovering from an episiotomy can be quite painful, though, so you’ll need to have regular pain relief. Hygiene after an episiotomy is very important to prevent infection. Washing your hands before and after changing your pads is essential.

These tips can help to relieve pain and discomfort following an episiotomy: 

  • Using a doughnut-shaped cushion or squeezing your buttocks together while you are sitting may also help to relieve the pressure and pain at the site of your cut. 
  • Placing an ice pack or ice cubes wrapped in a towel on the incision can often help to relieve pain. Avoid placing ice directly on to your skin because this could damage it. 
  • Keep the cut and the surrounding area clean to prevent infection. After going to the toilet, pour lukewarm water over your vaginal area to rinse it. 
  • Ask your midwife for pain relief.

More like this:

Labour pain relief options
Outlining your birth preferences
Water birth – what to expect

Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.


Ask Sarah

Q I’ve heard a lot about the Paleo diet and as I am very interested in reducing the amount of processed foods and grain based meals my family eats, we are considering following this diet. From what I read it seems to be a back-to-basics type of eating. Is a Paleo diet safe for children? My kids are aged seven and nine.

A The Paleo diet is one of the most fashionable diets around at the moment. It is also known as the ‘caveman diet’ and is based on cutting out processed foods, starchy foods like bread and potatoes and eating more meat, vegetables and fruit.
As fad diets go, it is not the worst but there are some good and bad sides to it. Reducing the amount of processed foods we eat is always a good idea and by doing that you will usually reduce the amount of fat, salt and sugar you eat, which is a good thing! The problem with the Paleo diet is that it also cuts out dairy (on the basis that cavemen didn’t drink milk) and this means that the diet is very low in calcium. For this reason it is really not suitable for children who do need a lot of calcium for growing bones. How did cavemen manage without dairy? They ate a lot more food than we do (up to 10,000 calories per day compared to the 2,000 most of us eat). By eating that amount of food they were able to pick up just enough calcium from green vegetables and seeds. To put it in perspective, you would need to eat 16 servings of broccoli a day to get all the calcium you need. This is easier to do if you eat 10,000 calories per day rather than 2,000.
The other problem with the paleo diet is that it is not entirely based in science. Many of the Paleo diets out there say you should not eat wheat, even though we know that cavemen did in fact eat wheat and other grains. These diets also don’t recommend that you eat blubber and the big lumps of fat that were also a large part of the caveman diet!
A final problem is that many Paleo diets encourage people to cut out beans and lentils and to get their protein from meat and fish instead. Many studies over the last few years are clear that eating too much animal protein is linked with more cancer and heart disease. Eating some vegetarian meals based on beans and lentils is a great way to get your protein without always going for meat.
Is this a diet we should follow? I think there is a lot we can learn from the Paleo diets. We could all do with eating less salt, sugar and processed foods and adding in more nuts and seeds as well as more vegetables. However, I think following a strict Paleo diet could lead to low levels of calcium and vitamin D and so it is not suitable for children or teens and adults would need to think about a calcium supplement.