Episiotomy during childbirthDecember 01, 2019

An episiotomy is a minor surgery that widens the opening of the vagina during childbirth. An episiotomy is a surgical cut made in the perineum during childbirth. The perineum is the muscular area between the vagina and the anus.

Many women get through childbirth without tearing on their own, and without needing an episiotomy. More recent research, however, suggests that an episiotomy may actually cause more problems than it prevents. The procedure can increase the risk of infection and other complications. Recovery also tends to be lengthy and uncomfortable. Episiotomies don't heal better than tears. They often take longer to heal since the cut is often deeper than a natural tear. In both cases, the cut or tear must be stitched and properly cared for after childbirth. At times, an episiotomy may be needed to ensure the best outcome for you and your baby.

 

• The mother isn’t able to control her pushing
• Labor is stressful for the baby and the pushing phase needs to be shortened to decrease problems for the baby.
• The baby's head or shoulders are too big for the mother's vaginal opening.
• The baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.
• Instruments (forceps or vacuum extractors) are needed to help get the baby out.
• You are pushing as the baby's head is close to coming out, and a tear forms toward the urethral area.

 

What Happens if I Need an Episiotomy?

Just before your baby is born and as the head is about to crown, your doctor or midwife will give you a shot to numb the area (if you have not already had an epidural).

Next, a small incision (cut) is made. There are 2 types of cuts: median and mediolateral.

A median incision is the most common type. It is a straight cut in the middle of the area between the vagina and anus (perineum).

The mediolateral incision is made at an angle. It is less likely to tear through to the anus, but it takes longer to heal than the median cut.

Your health care provider will then deliver the baby through the enlarged opening.

Next, your provider will deliver the placenta (afterbirth). Then the cut will be stitched closed.

How can I Avoid an Episiotomy?

You can do things to strengthen your body for labor that may lower your chances of needing an episiotomy.

• Good nutrition–healthy skin stretches more easily!
• Kegels (exercise for your pelvic floor muscles)
• A slowed second stage of labor where pushing is controlled
• Warm compresses and support during delivery
• Use of perineum massage techniques
• Avoiding lying on your back while pushing

 

Practice the techniques you learned in childbirth class to control your breathing and your urge to push.Keep in mind, even if you do these things, you may still need an episiotomy. Your provider will decide if you should have one based on what happens during your labor.

What are the Risks?

There are some risks to having an episiotomy. Because of the risks, episiotomies are not as common as they used to be. The risks include:

• The cut may tear and become larger during the delivery. The tear may reach into the muscle around the rectum, or even into the rectum itself.
• There may be more blood loss.
• The cut and the stitches may get infected.
• Sex may be painful for the first few months after birth.

 

An episiotomy is usually repaired within an hour after delivery. The incision may bleed quite a bit at first, but this should stop once your doctor closes the wound with sutures. Since the sutures dissolve on their own, you won’t need to go to the hospital to have them removed. The sutures should disappear within one month. Your doctor may tell you to avoid doing certain activities during recovery.

After having an episiotomy, it is normal to feel pain around the incision site for two to three weeks. Women who have third- or fourth-degree episiotomies are more likely to experience discomfort for a longer period of time. The pain may become more noticeable while walking or sitting. Urinating can also cause the cut to sting.

You can try to ease the pain by:

• applying cold packs on the perineum
• using personal lubricant when having sexual intercourse
• taking pain-relieving medications
• using a squirt bottle instead of toilet paper to clean yourself after using the toilet

Your incision should be completely healed within four to six weeks after delivery. The recovery time may be slightly longer if you had a third- or fourth-degree episiotomy.

My Womb maternity care provides specialized postpartum care or Post Delivery care all across Ernakulam, Cochin, Aluva, Thripunithura, Kakanad, Edapally, Kaloor, and all other Urban parts of Ernakulam District and Kerala. Our Post delivery care package concentrates on the speedy recovery of mothers after childbirth.  Special care is provided to recoup & rejuvenate the mother after child-birth. We know it better what Post Pregnancy care means to the mother.