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Understanding Episiotomy: Procedure, Benefits and Recovery

Chief Editor | Published on September 25, 2023

If you have been reading all about the different stages of labour, you are likely have come across the word episiotomy. What exactly is it and why would you need it?
Let’s delve into into the details of episiotomy, discussing its procedure, potential benefits, and what to expect during the recovery process.

What is Episiotomy?

An episiotomy is a surgical incision made in the perineum, the area between the vaginal opening and the anus, during the second stage of labor – to ease the delivery of the baby. This procedure is intended to widen the birth canal, facilitating the baby’s passage during childbirth.

This is mainly to prevent multiple and extensive tears (sometimes all the way to the anus) if the perineum isn’t able to stretch enough. A clean incision will help you to have a faster and smoother delivery and the wound from an episiotomy is a lot quicker to heal as opposed to spontaneous perineum tears.

This Sounds Scary — Is Episiotomy Necessary?

Your doctor or midwife will assess whether you need an episiotomy depending on a few factors. First-time vaginal births have a higher risk of perineum tears so doctors will often recommend the procedure.

If your baby suffers from foetal distress — meaning it doesn’t get enough oxygen — episiotomy will speed up the delivery. It’s also used to enlarge the vaginal opening if assisted delivery is required.

The Episiotomy Procedure

  1. Anesthesia: Before performing an episiotomy, your healthcare provider will administer a local anesthetic to numb the area, ensuring you do not feel pain during the procedure.
  2. Incision: Once the area is numbed, a small incision is made in the perineum. The incision can be midline (towards the anus) or mediolateral (angled away from the anus), depending on the healthcare provider’s judgment.
  3. Birth: After the episiotomy is made, the baby’s head can pass through the widened birth canal more easily, facilitating the delivery.
  4. Repair: After childbirth, the episiotomy incision is carefully stitched up using dissolvable sutures.

Will I Feel it During Labour?

In advanced labour, it’s unlikely you’ll feel the episiotomy since labour pain is quite a distraction in itself! If you have opted for epidural, it’s unlikely you would feel any pain. Even if you haven’t elected for any pain relief, a local anaesthetic will be administered by the doctor or midwife before an episiotomy.

Benefits of Episiotomy

  1. Preventing Severe Tears: Episiotomy can reduce the risk of severe tearing of the perineum, which can be more challenging to repair and may lead to long-term discomfort.
  2. Faster Delivery: In some cases, an episiotomy can expedite the birth process, reducing the time spent in the second stage of labor.
  3. Controlled Incision: Healthcare providers can control the size and location of the incision, potentially minimising damage compared to a natural tear.

Will it be Painful Afterwards?

The cut is usually not deep and the wound will be stitched up once you’ve given birth. The pain associated with episiotomy is likely to last a few days but you will be prescribed pain relief to manage it. Lying on your side and avoiding prolonged sitting will help to minimise discomfort. Cooling pads can also help reduce swelling and pain.

Recovery after Episiotomy and Caring for My Wound

  1. Pain Management: You may experience discomfort or pain at the episiotomy site. Over-the-counter pain relievers or prescribed medications can help alleviate this discomfort.
  2. Hygiene: Keeping the area clean and dry is crucial. Gentle cleansing with warm water after using the restroom and patting the area dry can prevent infection.
  3. Sitz Baths: Immerse your bottom in a small tub of salted lukewarm water (known as a sitz bath) three times a day. This can provide relief and promote healing.
  4. Avoiding Strain: Avoid activities that put pressure on the perineum, such as heavy lifting or strenuous exercise, until you are fully healed.
  5. Passing Motion: If you have hard stools, a mild laxative may be given to enable you to pass motion easily and to prevent the stitches from tearing.
  6. Pelvic Floor Exercises: Pelvic floor exercises, known as Kegels, can help strengthen the perineal muscles and aid in recovery.
  7. Follow-up Care: Attend all postpartum check-ups with your healthcare provider to ensure proper healing and address any concerns.

What are the Possible Complications?

Your episiotomy wound can become infected. If you notice red, swollen skin, a discharge of pus, persistent pain and an unusual smell, see your obstetrician as soon as you can.

Conclusion

Episiotomy is a surgical procedure that is sometimes necessary during childbirth to aid in the safe delivery of your baby and prevent severe perineal tearing.

While it is not always performed and should be discussed with your healthcare provider, understanding the procedure, its potential benefits, and the recovery process can help alleviate concerns and promote a smoother postpartum experience.

Always consult with your healthcare provider to determine the best approach for your individual situation.

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