Episiotomy – What, Why, How and Aftercare Explained

What is an episiotomy?

When is episiotomy necessary? Can it be avoided?

How to take care of episiotomy site?

My whole pregnancy was a cakewalk; manageable morning sickness, no swelling, no complications, a good amount of food cravings, no much back pain. I loved my pregnancy phase.

Though I had a long labour, I was fully satisfied and happy as I managed to deliver without epidurals. But the only one part I didn't like in this whole becoming the mother experience of mine was episiotomy.

Episiotomy- The word itself gives me pain. That was the only one part that made the postpartum days a horror for me.

I was aware what an episiotomy was and that I may need one if necessary. But I never expected that it would be one hell of a discomfort and pain during the postpartum days.

I really don't want to think of episiotomy, but as experiences are to be shared and as I like to help new to-be-moms, here is what I researched about this simple cut and ways to handle it postpartum.

What is an episiotomy?

An episiotomy is a cut made in the tissue between the vaginal opening and the anus during a vaginal delivery.

This is done to enlarge the vaginal opening in cases were the midwife or doctor feels that your vaginal opening is not big enough for the smooth or fast delivery of the baby.

You can also read about the 10 reasons why normal delivery is the best for you and your baby.

What is the need for an episiotomy?

During labor when your baby's head is crowning, the vaginal tissues start to stretch considerably especially at the opening of the vagina. Due to this stretching, in some cases, there is a chance of a spontaneous tear of the vaginal tissues when the baby is making way through your vaginal opening.

Obstetricians used to believe that a carefully made cut would heal more easily than a spontaneous natural tear and also will help prevent incontinence. Due to this belief episiotomy was a very common practice in olden days.

But recently the situation has changed, thanks to the researches that are being conducted in this area. Now obstetricians say that there is no proof to support the claim that an episiotomy is better than a natural tear. So the number of episiotomy has decreased considerably, but still many vaginal deliveries do have an episiotomy.

As said, though not a routine procedure now, certain situations demand an episiotomy.

Some of the situations that can warrant this procedure are

In situations were the baby is very large, a condition called fetal macrosomia, your vaginal opening may be too small for the baby.

In such situations your doctor may opt to do an episiotomy to widen the vaginal opening to easily manipulate the baby during delivery.

Some times during the last minutes of labor, your baby can go into a distress mode. His or her heartbeat can increase or decrease considerably indicating that he needs to be born quickly as he can no longer handle all the pressure of being born.

During such situations, an episiotomy is done to speed up the delivery.

If due to some reason an assisted instrumental birth is required for you, sometimes it may warrant an episiotomy too. Instrumental birth means using forceps or ventouse to deliver the baby.

Using such instruments requires the vaginal opening to be bigger for the instruments to easily do their job. This may call for an episiotomy.

Normally babies come out of the vagina head first. In some cases this is not the situation. They may be born leg first. This is called breach birth.

In breach position it is difficult for the baby to come out of vagina. So a breach birth may need an episiotomy to help widen the vaginal opening for easy delivery.

Sometimes a long labor can drain all your strength and can make you so exhausted that you lack energy to stay alert and push during the last stages of delivery.

In such cases also doctors may go for episiotomy if your not pushing at the right time is risky for the baby or you.

If you have any special medical condition that requires you to speed up the delivery, then an episiotomy may be used.

An experienced midwife may know from experience if your vaginal birth can lead to a spontaneous natural tear that can be worst to handle than an episiotomy.

In such cases an episiotomy may be performed to avoid a serious natural tear.

How is an episiotomy done?

If your midwife or obstetrician decides to do an episiotomy, you will be given a local anesthetic to numb the area around your vagina. Then a surgical scissors will be used to make an incision in your perineum just before the birth of your baby.

In some cases if you are already on epidurals or if your perineum is numb and too much stretched out from the pressure of your baby's head, an episiotomy may be performed without local anesthesia or pain medication.

After you have given birth to the baby and the placenta, the cut will be stitched up using a self-dissolving suture material, which does not require to be removed later. A local anesthesia will be given again to make sure you are not getting the pain when the stitches are done.

Types of episiotomy:

There are four types of episiotomy. The two types of episiotomy incisions that are commonly used are-

A midline or median incision is done vertically starting from the vaginal opening towards the anus. This type of incision is the easiest to repair, but the risk is that it can extend into the anal area or cause a third degree or fourth degree perineal tear.

In a mediolateral incision, the perineal tissue is cut diagonally at an angle from the centre of the vaginal opening outwards towards the hipbone. A mediolateral incision lessen the chances of perineal damage, but is often more painful and difficult to repair.

The other two types are lateral incisions and J-shaped incisions and are not widely practiced due to the increased risk of side effects.

Episiotomy aftercare and healing

An episiotomy cut normally heals by 4 to 6 weeks postpartum. The degree of the cut as well as the material used to stitch up the wound will determine the length of the healing time. The stitches normally need not be removed as they dissolve on their own.

After an incision and stitches the most difficult part will be urination and passing the bowel movements, as both these activities put pressure on the wounded area and it can cause extreme pain. The tear will be in your most tender area and so proper care is necessary for quick healing of the wound.

Here are some instructions for proper aftercare and easy recovery from the wound-

• Ice packs or cold compresses can be used to numb the area and for pain relief during the first 24 hours.
• Pain relievers can be taken under doctor's advice. Never take aspirin as it can be passed to baby while breastfeeding.

Always keep the incision area clean to avoid infection. Pour warm water over your perineum every time you finish pee or poo. Always clean from front to back, away from your vagina, to avoid infection.

Use a soft towel to pat dry the area. Don't use wet wipes or tissue.

• Sit in a tub full of warm water for 20 minutes several times a day. This is called a Sitz Bath and can help to relieve pain. Use a sitz bath only after 24 to 48 hours of delivery.
• Use a local anesthetic ointment after doctor's prescription.

Avoid straining too much when you pass stools. This can put pressure on the stitches. Stay hydrated and eat fibrous healthy foods to avoid constipation. Constipation can make things worse. Use a stool softener if constipation is too much.

Be without your panty for 10 minutes or so, once or twice a day. Expose your stitches to the air. Contact with fresh air will speed up the healing process.

Change the pads every 2 to 4 hours to avoid infections.

Don't use tampons or douches in the postpartum period. This can interfere with the healing and can lead to re-injury.

You may use a cushion when sitting to lessen the pain.

No sexual intercourse until the wound is completely healed. This may take anywhere from four to six weeks postpartum.

Practice pelvic floor exercises to help improve blood circulation around the wounded area. This speeds up the healing process.

When to worry?

Normally when taken care in the proper way the stitches dissolve and the wounds heal without any complications.

But seek medical attention if you see any of the below symptoms-

• Urine or stool is leaking and you are not able to control it
• You pee very less in quantity or you are not urinating at all
• The area around the wound is swollen, warm, or red
• A hard or painful lump is developed on or near your stitches
• A pus or yellow liquid is oozing from your wound
• Your wound breaks open
• Episiotomy stitches coming out
• Your stitch is not showing signs of dissolving even after a month
• Suddenly blood is coming from the wound
• Pain is worsening day by day

Episiotomy complications

A third or fourth degree cut can cause problems with gas and feces control.

Sometimes excessive scar tissue can form over the episiotomy site. This scar may be raised and/or itchy. A Fenton's procedure may help to solve this condition.

Intercourse can be painful after episiotomy.

Sex after episiotomy

You should wait for 4 to 6 weeks or until after the wound has completely healed to resume penetrative sex.

A third or fourth degree episiotomy repair may take more time. If you had one, it is recommended that you get examined first by a doctor and do sex only after a green signal from your doctor.

You may feel difficulty when you resume sex after episiotomy. It can be tight and tender at the region and initially sometimes painful. Relaxing as much as possible, going for long foreplays and using a good lubricant can help lessen the discomfort.

Talk openly with your partner what is bothering you and how you feel after an episiotomy. This will help your partner to do things slowly and without causing much difficulty for you. Try out comfortable positions that help you control the degree of penetration. This can help decrease the pain and discomfort on the initial days of sex.

If you have pain or discomfort even after taking all the precautions, please consult a doctor to check if anything is wrong.

How can I avoid or lessen the chances of an episiotomy?

A perineal massage can help reduce the need for an episiotomy. Starting around 34 weeks of pregnancy do daily perineal massages. This may help to increase the area's ability to stretch. When your perineal tissue's ability to stretch is increased there is less chance of natural tears and need for an episiotomy.

Talk to you doctor to find out the correct instructions on how to do a perineal massage and if it is ok for you to do one.

Doing kegel exercises can also help.

Avoid an epidural during the second stage of birth. Having an epidural at this stage may make you incapable of feeling the urge to push. If you're unable to push well an assisted birth may be required which can warrant an episiotomy.

Show patience while pushing. I know this is not possible as you will be in no good mood to show patience at this crucial moment. But still try. Relax in between and push only when you have the strong urge to do so.

Read:

So this was about what, why, how and aftercare of episiotomy.

Hope the article was helpful.

Did you have an episiotomy? How long did it take to heal?