"Episiotomy" is defined as the procedure wherein an incision is made in the perineum, between the vagina and anus, to increase the size of the vaginal opening during child birth. Although it was routinely performed a few years back, research today claims that natural vaginal tears heal better and have a shorter recovery time. For this reason, preference of episiotomies is coming down in obstetric practice.
An episiotomy is measured in degrees, with the most common one being a second degree tear, which just involves the skin between the vagina and the anus. The least common is a fourth degree tear, which involves extensive damage to the muscles between the vagina and the anus, resulting in faecal incontinence. These tears cannot heal naturally and will need to be surgically repaired.
When Is It Necessary?
The following conditions warrant a perineal incision:
- baby needs to be delivered urgently
- baby is in an abnormal position
- baby’s head is too large for the opening
- baby is in distress
- need a forceps or ventouse assisted delivery
- mother is either tired or unable to control pushing
If an epidural is used as a pain relief option during birth, further anesthetic might not be required. Otherwise, a pudendal block will be used to numb the area before making an incision.
What Can You Do To Prevent An Episiotomy?
Softening the tissue is often recommended by healthcare providers. This can be achieved by doing a perineal massage about six weeks before your due date. After washing your hands well, take some olive oil or lubricant onto your thumbs. Place your thumbs just inside your vagina and press downward toward your rectum and hold for one to two minutes. Then, slowly massage the lower half of your vagina. Repeat the massage once a day for 10 minutes up until the delivery.
It might be difficult for a woman to do this on her own at this stage of pregnancy; therefore one might take the help of a partner.
Apart from a massage, doing Kegel exercises to strengthen pelvic floor muscles, giving warm compress and support during labour, avoiding a lying down position at the time of pushing are things that might help.
Recovering From An Episiotomy
Sutures used for an episiotomy are soluble and the wound takes about six weeks to heal depending on the size of the incision. To aid the healing process, here are few things you can do:
- Soothe the wound: Applying cold packs on the perineum will help soothe the wound. Maxi pads with built in cold packs are available in stores. Chilled witch hazel pads also help and are available at pharmacies.
- Rinse the area: Rinse the area with warm water using a squirt bottle each time you use the toilet. Sitting in a bath tub with warm water for a while also helps. Pat dry the wound instead of wiping.
- Do not allow urine to sting:Urinating can sting. Squat rather than sit on the toilet seat, or sit in an angle to prevent urine flowing over your wound.
- Avoid stretching during bowel movements: The first few bowel movements after an episiotomy can be uncomfortable. Although it might feel that your stitches may give way, this hardly ever happens. To relieve pressure, press a clean pad firmly against the wound as if to give support.
- Use medication: Doctors might provide pain relief medications, which need to be taken according to the doctor's instructions.
- Keep an eye on infections: Sometimes, an episiotomy results in an infection. If you notice a pus- like discharge, the area feels warm to touch or is swollen and if there is unbearable pain, contact your doctor immediately.
While research today strongly favours natural tears to an episiotomy, there are some doctors who still very strongly support the procedure as they feel a surgical intervention is controlled and easier to repair than a spontaneous irregular tear. But remember to voice your opinion and state clearly in your birth plan that you wish to avoid it unless absolutely necessary. And if the procedure is unavoidable, follow the postpartum care to have a safe and fast recovery.
References:
American College of Obstetricians and Gynecologists (ACOG) 57th Annual Clinical Meeting: Papers on Current Clinical and Basic Investigation. Presented May 5, 2009.
Medline Plus
 |
