Episiotomy
An episiotomy is a surgical
incision used to widen the entrance to the vagina to facilitate childbirth.
Under what circumstances may an episiotomy be required?
An episiotomy may be required
for any of the following reasons:
- Birth is imminent and the perineum hasn’t had time to stretch slowly
- The baby’s head is too large for the vaginal opening
- The baby is in distress
- The mother needs a forceps or vacuum-assisted delivery
- The baby is in a breech presentation and there is a complication during delivery
- The mother isn’t able to control her pushing
How is it done?
If you've had an epidural
before, you probably won't need other anesthetics. Otherwise, it will be
necessary to use a local anesthetic, called a genital block, in the perineum.
The median-lateral cut descends down from the vagina and perineum into the
muscle.
The midline incision is made
directly in the perineum, between the vagina and the anus.
How to prevent the need for an episiotomy?
The following measures may reduce
the need for 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 massages techniques
- Avoiding lying on your back while pushing
Can they be harmful?
An episiotomy has the
following potential side effects:
- Infection
- Bruises
- Swelling
- Bleeding
- Increased healing time
- Painful scars that may require a period of abstinence from sexual intercourse
- Future incontinence problems
What are the pain management options for episiotomies and tears?
- If you end up having an episiotomy or tearing of the vaginal opening, you can try some of the following solutions to help relieve the pain.
- Cold compresses on the perineum. Ask your doctor about special maxi towels with built-in cold compresses.
- Take a sitz bath - a portable bath that you put over the toilet and let the warm water cover the wound.
- Use a personal lubricant when you resume sex.
- After visiting the toilet, instead of drying yourself, wash yourself with a spray bottle. Patting instead of wiping can also help.
What if I want to avoid an episiotomy?
Make it clear in your birth plan that you do not want an episiotomy unless absolutely necessary. Also discuss the problem with your doctor during your routine prenatal care.