Episiotomy: The Cut That No One Deserves, But Sometimes Needs

So just what is an episiotomy?

In the simplest of terms, an “episiotomy” is a cut made in the perineum (area between the vaginal opening and anus) to help widen the vaginal passage and facilitate a normal delivery. In some cases, an episiotomy is performed to prevent a vaginal tear during normal delivery, which is much harder to repair and much more complicated to live with.

Just a few decades earlier, normal delivery with episiotomy was common practice. However, episiotomy complications and concerns about infection and incontinence have led many doctors to perform an episiotomy only when there is no other choice. The decision to perform an episiotomy is weighed against the potential risk of not doing so.

 An episiotomy may be performed when:

  • The baby is in distress and needs to be born quickly.[1]
  • The only available alternatives are forceps and vacuum. [1]
  • The mother may have a medical condition that necessitates speedy birth. In such cases, an episiotomy speeds up the process. [1]
  • After a long labour, the exhausted mother may need an episiotomy to deliver the baby faster and with ease. [1]

However, not all is rosy with an episiotomy:

  • Like any other procedure, an episiotomy can cause postoperative pain.
  • An episiotomy can increase the risk of fecal incontinence and the uncontrolled release of gas when compared to women who haven’t had the procedure.[2]

Life After Episiotomy:

Episiotomy stitches can take up to six weeks to heal. Perineal care must be followed as instructed during this time. Doctors recommend a daily cleaning procedure as well as dos and don’ts for bathroom usage that the new mother must follow. Until the episiotomy stitches heal, sex is out of the question. Even afterward, it is better to ease into the process gently to not cause any further tears and discomfort.

Perineal Tears May Occur Naturally During Labour:

The perineum may tear to some extent during childbirth. Based on the degree of tearing, they are classified as[3]:

  • First-degree tears – small, skin-deep tears which usually heal naturally
  • Second-degree tears – deeper tears affecting the muscle of the perineum as well as the skin; these usually require stitches

More severe perineal tears:

  • A third-degree tear extending downwards from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus
  • A fourth-degree tear extending to the anus or rectum

Repair of third-degree and fourth-degree tears requires appropriately trained clinical personnel and regular follow-up. Broad-spectrum antibiotics are recommended as part of post-operative perineal care to prevent infections, and laxatives to ease passage of stools. A woman who has undergone an episiotomy or tear repair procedures should also be counseled on their impact on any future deliveries, and made aware of her childbirth options[3].

Did you undergo an episiotomy and/or its complications? What was your experience like? Write to us at info@togetherforher.com!

References:

 

  1. NCT New Parent Support.
  2. Signorello, Lisa B., Bernard L. Harlow, Amy K. Chekos, and John T. Repke. “Midline episiotomy and anal incontinence: retrospective cohort study.Bmj 320, no. 7227 (2000): 86-90.
  3. Royal College of Obstetrician and Gynaecologists (UK) Patient Information Leaflets
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