Episiotomy

Overview

During an episiotomy, your obstetrician will create a small incision between the bottom of your vaginal opening and the anus (also known as the perineum) when you give birth. Your vaginal opening will widen after an episiotomy, making it easier for your baby to pass through. Your perineum may occasionally naturally tear as your baby is delivered. This is referred to as a perineal laceration or tear.

Doctors would want you to tear naturally and do not advise routine episiotomies. Nonetheless, the process is still applied in some circumstances.

Reasons for undergoing the procedure

Even though they are uncommon, there are still situations in which your doctor believes an episiotomy to be the safest course of action. Among these are the following examples:

• Your infant is substantially larger.
• The extended labor has left you drained and fatigued.
• You’ve exerted force for an extended period or are unable to manage the pushing.
• Your baby is breech or has shoulder dystocia (shoulders are lodged in your pelvis).
• Your baby needs to be delivered right away since they are in distress.
• To deliver your baby, your obstetrician will need to use a vacuum or forceps. You might need to enlarge your vagina in order to use these devices.

Types of episiotomy incisions

Two primary methods of incisions:

• Median (midline): A cut that runs vertically, or up and down, from the vaginal opening to the anus. This type of incision carries a greater risk of tearing the anal sphincter or rectum, although it is a simpler incision to perform.
• Mediolateral: An angled or diagonal incision. Starting at the vaginal opening, the incision extends at a 45-degree angle. The anal sphincter and the rectum are less likely to be affected by the incision. Mediolateral incisions have several drawbacks, such as increased blood loss, discomfort during the healing process, and difficulties in repair.

Degrees of episiotomy

Similar to perineal tears, doctors categorize episiotomy levels or degrees according to the severity of the tear. There are three levels to an episiotomy:

• First-degree: A tiny tear that includes simply the lining of your vagina.
• Second-degree: a tear that penetrates your vagina’s lining and reaches the vaginal tissue underneath. The majority of episiotomies are classified as second-degree.
• Third-degree: A tear that encompasses the vaginal lining, vaginal tissues, and extends to the anal sphincter.
• Fourth-degree: The rectum, anal sphincter, vaginal tissues, and vaginal lining are all impacted by the tear. This type is the most serious tear type with the greatest number of complications.

Risks

The following complications are possible as a result of an episiotomy:

• Infection
• Scarring
• Bleeding
• Urinary incontinence
• Extended recuperation period
• Damage to the rectum and anal sphincter
• Dyspareunia or pain during sexual intercourse

It is noteworthy that a natural tear can also result in the problems mentioned above.

Before the procedure

• You may ask questions after your doctor explains the process.
• To allow the procedure to proceed, you will be required to sign a consent document. Carefully review the form, and if something is unclear, feel free to ask questions.
• If you have any sensitivities or allergies to any medications, iodine, latex, tape, or anesthesia, let your doctor know.
• Report to your doctor all medications you take, including over-the-counter and prescription ones, as well as vitamins, herbs, and supplements.
• Let your doctor know if you have a history of bleeding issues and if you take aspirin, anticoagulants, or any other medications that interfere with blood clotting. These medications might need to be stopped before labor.
• Comply with any further preparation instructions provided by your doctor.

During the procedure

An episiotomy is carried out during a delivery by vagina. Depending on your condition and your obstetrician, the exact procedure could change.

An episiotomy typically happens in this manner:

• Anesthesia will be administered to you to prevent pain. Should you have previously received an epidural, your lower extremities are devoid of feeling. It’s possible you won’t require any further anesthesia. Your doctor will inject a local anesthetic into your perineum if you haven’t received an epidural.
• When the baby is pushing against the perineum and crowning (head at vaginal opening), the episiotomy incision is made by your doctor using episiotomy scissors.
• After your baby is born, the placenta is subsequently delivered.
• To repair the injured muscles and tissues, your doctor will use absorbable stitches. They assess the extent of the rip and look for any complication.

After the procedure

Following an episiotomy, pain at the site of incision may occur. Using an ice pack can help lessen discomfort and swelling. Sitz baths, whether warm or cold, can reduce discomfort and expedite the healing process. Sprays for local numbing or medicated creams may also be beneficial.

You can follow your doctor’s recommendation and take a pain medication. Make sure you only take medications as prescribed.

Make sure the incision is clean and dry by following your doctor’s instructions. Following defecation and bowel movements, this is crucial. Stool softeners that your doctor has advised might be useful if your bowel movements are painful.

Wait to use tampons, have sex, or douche until your doctor gives the all-clear. Other restrictions on your activity can include refraining from heavy lifting or physically demanding activities.

Unless your doctor instructs you otherwise, you can resume your regular diet.

When you should go back for additional care or treatment will be specified by your doctor.

Outcome

Healing takes roughly one month, but this can vary depending on the degree of episiotomy. Healing times for natural tears are often the same.

Having pain and soreness is common in the first few weeks, and discomfort during intercourse may also be present (after receiving the all-clear to have sex). Inform your healthcare physician about your level of pain and how you are healing. Depending on the kind and extent of your episiotomy, they can determine whether or not it’s typical.