Episiotomy

What is Episiotomy?
An episiotomy is a straight cut through the muscle and connective tissue in the perineal area to enlarge the opening of the vagina. The decision to perform an episiotomy is usually made as the baby's head begins to emerge.

It is generally done in one of two ways:

  • Midline cut made from the vagina towards the anus or

  • Mediolateral cut made from the vagina sloping out to one side

An episiotomy can be done under local anaesthetic although for a small episiotomy, this is not always necessary as the pressure of the baby's head on the perineum can numb the feeling. The number of stitches required is related to the size and depth of the cut. The larger the incision, the longer it will take to heal, often causing tenderness, discomfort and swelling for days, sometimes weeks afterwards. Since the incision is made through both skin and muscle layers, careful repair of the wound afterwards can take as long as an hour, often requiring local anaesthetic.It is advisable to check the wound daily for signs of possible infection and to make sure the stitches haven't dropped out and become imbedded in the tissue.

Is an Episiotomy necessary?
Episiotomies are usually carried out when there are signs of the baby becoming distressed, the birth needs to be hastened or in cases of forceps delivery. For some women, the appropriate use of episiotomy is important. Medical professionals believe episiotomy reduces the chance of uncontrolled tearing of the perineal tissue that can be more difficult to repair. It is also believed that prolonged pushing can have a negative long-term impact on pelvic floor function and that shortening the second stage of labour is better for the baby. Though there are many arguments against episiotomy, there are always situations where an episiotomy is fully justified.

Problems arising from Episiotomy

Following are a few problems that might arise out of Episiotomy.

  • Unnecessary bleeding if performed too early, as the tissue has not thinned enough

  • Increased chance of further tearing the episiotomy incision

  • Infection of stitches requiring antibiotics

  • Incontinence

  • Long-term discomfort during sexual intercourse

  • Pain, swelling, tenderness for days, even weeks afterwards

  • Excessive stress and pain far greater than that of superficial tearing

Things You Can Do To Avoid Episiotomy

  • Certain birthing positions help you avoid episiotomy. These include positions used in active birthing methods such as being on hands and knees, squatting, upright and using a birth stool.

  • Do perineal massage during the last two months and regularly do your pelvic floor exercises.

  • Maintaining a good diet will promote the skin's elasticity and will help avoid episiotomy.

  • You should time your labour properly. The most common cause of tearing is not allowing time for the perineum to stretch. At this time, strong sensations encourage a desire to push the baby out, though timing is crucial to allow the surrounding tissue to stretch and thin in preparation. Proper timing will help avoid episiotomy.
Aftercare
The pain related to episiotomy and tearing is primarily from swelling and inflammation. Using icepacks can help. Soaking in a salt or lavender bath can be soothing and relieving. Rather than towel drying the area, a hair dryer can be useful.

 

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