Episiotomy

Tips to avoid the cut and help with episiotomy care

Just thinking about an episiotomy is enough to make most women cringe, but the fact remains that this small incision is a common part of childbirth. Often only a few centimeters long, the purpose of an episiotomy is to widen the opening of the vagina so the baby can be delivered more quickly and easily. However, like other medical interventions during labor, people are divided on whether it truly helps or just brings unnecessary pain and risk. An episiotomy is used in about 40 percent of vaginal deliveries, but that number is decreasing each year, and the consensus is that the procedure should not be done routinely.

 

Since it is an incision, the aftermath is often uncomfortable and episiotomy complications are not unheard of. On the other hand, there are medical reasons to justify a small cut in the perineum, so you might not want to automatically strike it from your birth plan. Learn about how the procedure is conducted and when it may be the best course of action.

Who Needs an Episiotomy?

One major aim of episiotomy is to prevent vaginal tearing, which is much more unpredictable, uncontrollable and potentially harmful to your health than an intentional cut. Many also believe that episiotomy is a great way to speed up the birth -- an act that is not only convenient, but also medically recommended in some cases. It's especially helpful when the mother has a medical problem and can't handle a difficult delivery, for breech births or if there are signs of fetal distress during delivery. Since the incision typically goes straight down and stops well before the rectum, an episiotomy doesn't usually interfere too much with those muscles, and local anesthesia will reduce the pain considerably.

However, most will agree that if an episiotomy can be avoided, it should be avoided. Begin to condition your pelvic area early with perineal massage to lessen the chance that you'll need an episiotomy, and continue with your pelvic floor exercises so you'll have the energy to cope with the pushing stage. On the other hand, remember that length or complications in delivery cannot always be predicted, so prepare yourself in case the health of your baby requires that you have the incision.

Episiotomy Repair and Complications

After you deliver, your doctor will stitch the cut together quickly. You likely won't even notice this part, since you've turned all of your attention to your new baby, but you could be given more local anesthetic if the cut is fairly deep. This is when complications can begin to arise, as the skill of the doctor or midwife can determine how well the cut will heal: a poorly stitched wound could reopen, heal unevenly and become infected. But even a well-sutured wound could be painful and even cause bowel incontinence if the rectum is injured, and it may be quite a while before you can comfortably have sex.

Luckily, with meticulous hygiene and careful attention, you can help your wound heal faster (perhaps in one month instead of two) and you should be able to sidestep any major complications. If the itching and soreness are distracting, take warm baths as often as needed, clean the area with water after visiting the toilet and use sanitary pads soaked in witch hazel, which is a natural anti-inflammatory, to bring quick relief.