Episiotomy has been done for so many years to help prevent vaginal tears during childbirth. It is an incision made in the tissue between the vaginal opening and anus to ease the delivery and help the tear heal better than a natural tear.
In some cases, during vaginal birth the vaginal opening does not stretch enough to accommodate the fetus. Episiotomy is done to help enlarge the vaginal opening. Although it was a part of routine childbirth before, it is no longer recommended by the ACOG as some studies found that the routine use of episiotomy does not benefit both the mother and the baby.
When an episiotomy is done
Although episiotomy is no longer recommended like it was before, it is still done in some special cases like:
• Your baby’s shoulder is stuck behind your pelvic bone or your baby has shoulder dystocia. This happens when the baby is proportionately too big for the birth canal.
• Your baby has an abnormal heart rate pattern during the delivery which may cause your baby respiratory distress.
• You need an operative vaginal delivery by using a vacuum or forceps to help cradle the bones of the baby’s skull, while applying traction to help the baby pass through more easily.
• Your baby is big and may need a roomier exit route.
• Your baby has a prolonged second stage of labor.
• Your baby’s presentation might be in breech or a feet first delivery.
• Your baby is a preterm baby.
Types of incisions
There are 2 types of episiotomy incisions:
Mid line incision or median incision – also called a vertical incision. This is done in the lower opening of the vagina towards the rectum. This area is vascular and tends to heal well, but the incision may extend to the rectal area and cause a 3rd or 4th degree of laceration.
Mediolateral – This incision is made at a 45 degrees angle from the lower opening of the vagina. This type of episiotomy does not extend its tear but may cause a greater amount of blood loss and is more painful and difficult to repair.
Before the procedure
Your healthcare professional will explain the procedure to you and offer you the opportunity to ask any questions about the procedure. You will also be asked to sign a consent. Make sure to read all the contents of the consent carefully and ask if you can’t understand some terms. Tell your doctor if you have any medicine allergies, or allergies of iodine, latex, tape and anesthetic agents. Also, give them a list of all the medications you are taking, whether it be over-the-counter, prescribed or herbal supplements. It is important also to inform them if you have bleeding disorders or if you are taking blood thinners as this may affect the healing time for the procedure and may cause significant amount of blood loss.
During the procedure
If episiotomy is done to you, you will be positioned properly on the delivery table. You will not be given a general anesthesia but you will be injected with local anesthetic in the perineal skin to numb the tissues and muscles around where the incision will be made. During the second stage of labor, when your cervix is fully dilated and you are about to deliver the fetus, the doctor will make an incision using special scissors or a scalpel and deliver the baby.
Any stitches done to repair the episiotomy will eventually be absorbed. You will experience incisional pain that may be relieved by using ice packs. This will help in reducing the swelling and pain. Once you leave the hospital, you will be advised to do warm sitz bath. A sitz bath is a warm, shallow bath that helps cleanse the perineum. It helps relieve some soreness and speeds up the healing process of the incision. Medicated creams or local anesthetics may be prescribed by your doctor which are applied on the perineum may also help in decreasing the pain.
Make sure to always keep the incision clean and dry by cleansing it using the right method, especially after urinating and bowel movements. If you are having a hard time during bowel movements, it is advisable to use stool softeners. You should not douche, use tampons, or have sexual intercourse until the wound is healed and until you are instructed by your doctor. Strenuous activities and heavy lifting should be avoided and also stress. You may resume your normal diet unless otherwise contraindicated by your doctor.
Make sure to come back for further treatment and care and to also notify your doctor when you experience any of the following:
• Bleeding from the episiotomy site
• Foul-smelling drainage from the vagina
• Fever and chills
• Server perineal pain
How to reduce risk for episiotomy
To reduce the chances that you might need an episiotomy during delivery, you may need to:
• Talk with your healthcare practitioner and express your desire of not wanting to have an episiotomy and your reasons for it.
• If you have a birth plan, don’t forget to include it in there.
• Do Kegel’s exercises throughout your pregnancy.
• Do perineal massage for 6-8 weeks prior your due date.
• Place a warm compress on your perineum during labor to relax and soften the muscle and skin in the area, giving it a better stretch.
• Stand or squat while pushing the baby out.
• Some practitioners apply counter pressure in the perineum as the baby’s head emerges to assist you from pushing out too quickly and causing unnecessary teari.