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Episiotomy

Sep 22, 2014

Perineum is the tissue that lies in between the anal and the vaginal opening. Episiotomy refers to an incision made in this tissue at the time of childbirth. Episiotomy was once regularly performed during childbirth, this; however, is no longer the case. Only when you have much difficulty in delivering the child naturally, will the doctor resort to episiotomy. If you plan to have a vaginal delivery, you should have ample knowledge about childbirth and episiotomy.

Tear Naturally vs. Have an Episiotomy

According to research, it has been shown that females who tear naturally during birth usually recover in similar or lesser time than females who had an episiotomy during birth. They also suffer fewer complications.

There is more blood loss in females with episiotomy, and recovery is more painful. Moreover, the females with episiotomy will have to wait for a longer duration to have sex without pain and discomfort. The risk of infection is increased with episiotomy along with the risk of having a tear during the next delivery.

Episiotomy is also associated with an increased risk of getting a serious tear that goes through the anal sphincter and rectum. These tears may cause excessive pain in perineum, and require longer time to recover fully. A tear that goes through the anal sphincter may lead to the development of anal incontinence (loss of control of bowel movements).

When Do You Need an Episiotomy?

Episiotomy may be needed in the following situations:

During the time when the head of the baby is close to coming out of the vaginal cavity, you are pushing and a tear develops towards the urethra.
If labor is causing stress to the baby and the phase of pushing has to be decreased so as to minimize the problems developing in the baby.
If the vaginal opening of the mother is not sufficient enough for the head and shoulders of the baby to come out.
If feet or buttocks of the baby come out first (breech position), which is causing problems during delivery.
If the delivery of the baby requires the use of instruments such as forceps or vacuum extractor.

Episiotomy is not needed by every woman during childbirth. Childbirth is carried out in many women on their own and they don’t tear or require a cut.

How to Avoid an Unnecessary Episiotomy

Discuss with your obstetrician about the procedure. Ask her questions such as: what are your chances of getting an episiotomy, under what circumstances an episiotomy is done, and how will she help you to prevent tearing.

You can try doing massage of the perineum beginning five to six weeks before giving birth. According to few studies, doing perineal massage decreases the risk of your getting a vaginal tear or an episiotomy.

How Is Episiotomy Done?

If your obstetrician decides that you need an episiotomy during childbirth, she will inject local anesthetic in the perineum and make a small cut using surgical scissors in the perineum just before the baby is coming out. She may opt for not giving pain medication if your perineum is already thinned out and numb from the pressure of the head of the baby.

After your baby is delivered, your obstetrician will again inject local anesthetic in the perineum before stitching the cut.

What Are the Risks of Episiotomy?

As with all the surgical procedures, episiotomy is also involved with some risks. These risks are as follows:

The cut given during episiotomy may tear and become larger when the baby is coming out and may even go through the anal sphincter and rectum.
The blood loss may be increased.
There is an increased risk of infection of the cut and stitches given during episiotomy.
You may feel pain during sex for the initial few months after delivery.

How to Heal From Episiotomy?

With 10 days after delivery you will be on the way to healing and after about a month your stitches will heal. If you develop any signs of infections such as foul odor from the wound or problems during urination, call your obstetrician immediately. If you are unsure of the healing of the stitches, ask your obstetrician to examine the perineal area properly.

You can also take measures to promote healing of an episiotomy wound:

Soothe the area with ice pack or witch hazel	You can put an ice pack to the affected area. You can also put a witch hazel pad (chilled) in between the wound and a sanitary pad. Witch hazel pads are available in most of the pharmacies.
Prevent stinging during urination	Pour warm water on your vulval area, while you are peeing using a plastic cup. You should also rinse yourself using a squirt bottle after urinating.
Avoid stretching and pain during bowel movements	While you are pressing for a bowel movement, press firmly a clean pad on the episiotomy wound.
Be careful while sitting	When you lower yourself while getting seated, make your buttocks tight. Avoid sitting on a hard surface and use a soft pillow to sit.
Take pain medicines as required	You may be recommended to take pain reliever medications and stool softeners by your physician. Use them when needed to relieve the pain.
Opt for complimentary treatments	According to some research, the pain of an episiotomy is reduced by using lavender. After taking approval from your physician, you can add to your bath water a few drops of lavender essential. You can also directly apply the oil to the affected area (the tissue in between your anal and vaginal opening).

When Can You Have Sex After an Episiotomy?

You can have sex after the stitches of episiotomy have healed. You might feel some tenderness and discomfort in the episiotomy wound initially, however, the pain with decrease with time. You can use a water-based lubricant to ease the discomfort. Try to relax as much as possible during sexual activity.

Try positions in which you have the control on the degree of penetration and less pressure is caused to the wound. Have a warm bath before having sex and have sufficient time for foreplay.