Even the word Episiotomy is enough to make a pregnant woman cringe. But when it comes to childbirth, it could be very thing that will make giving birth that much easier.
So, what exactly is an episiotomy?
To put simply, Episiotomy is the cut your doctor puts between your vagina and rectum through your perineal tissue to make the opening of your vagina wider. The cut will be made large enough for your baby to fit through but will be done with extreme precision so not to damage anything permanently.
You may need an episiotomy to help things along if your baby is breech or premature or if you have high blood pressure, so you don’t have to push so hard. Or you may be completely exhausted from labour, and need a little help to cross the finish line.
Episiotomies were very routine procedures have have been practiced for generations, so there is no need to worry. They are more common than you think.
To understand an episiotomy, you first have to understand a woman’s anatomy, here is a quick lesson.
The perineum is a very important part of a woman’s body and it plays a special role during childbirth. It is the area of skin and muscle found between the vagina and anus. During childbirth it stretches to allow the baby’s head through. An episiotomy is the cutting of perineal tissues during delivery.
How is it done?
The midwives will lye you down with your feet in stirrups, while the doctors cleans your perineum with antiseptic and then the area will be number with a local atheistic. Don’t worry if you’re afraid of needles, you won’t know its coming and it’s not painful.
If you’ve already had an epidural, they might give you a little extra to completely numb the area. But either way, you won’t feel a thing. If you do, alert your midwife or doctor immediately.
The cut is made with a pair of special scissors or a scalpel at a slight angle. Depending on the doctor, you could be cut across or straight down, it’s a much of a muchness either way.
Types of Incision
There are 2 main types of incision.
The incision starts midline at the base of your vagina and directed diagonally to the left over the right side to a point midway between the anus and ischial tuberosity, avoiding the anal sphincter.
The incision starts in the midline position and is made vertically towards the anus.
Once this is done, don’t be surprised if your baby is born almost immediately, after all there is a lot more space now for him/her to move down and out!
Once your baby has arrived and you’re cooing with glee, the doctor will begin stitching you up. This can take around 30 minutes, depending on the size and depth of the cut.
It is thought that the benefits of episiotomy are greater than just taking the chance of naturally tearing because the wound has a better chance of healing and the scar will be minimal.
What’s the recovery like?
Because this area has high blood-circulation, the wound should heal within six weeks, or less. It’s very rare that you’ll need anything re-stitched, but if you do then see your doctor.
Hygiene is an important one to remember as it has a great effect on how well an episiotomy heals. A good after-care routine should include a healthy, balanced diet and regular bathing, as well as changing your maternity pads regularly.
If you’re worried that going to the toilet will open up your stitches, don’t be, just try to relax when you need to go and try not to push or strain.
Also, sex might be out the window for a few weeks – remember your body has gone through a lot and you need to give it time to heal properly.
What Does it Feel like?
Sonya tells her story:
“I had an episiotomy with my first child as pushing just wasn’t cutting it – I was fully diated but he just kept getting stuck at the entrance to my vagina. I don’t recall getting the anaesetic there – I was probably in too much labour pain anyway to notice. Once they cut, he just ‘flung out’ – birth was no problem.
My Gyno stitched me up a short while later – I do remember it stung a little.
For the first few days it was sore. I had lots of salt water baths, and I put pressure on it with a soft cloth if I needed to go to the toilet. I was numb in that area for quite awhile. But it did heal very quickly and wasn’t nearly as bad as I thought it might of been!”
Can maternal injuries from childbirth be prevented?
Sometimes. You are less likely to have a vaginal injury during childbirth if you control your pushing when you give birth. This helps the perineum to stretch slowly, making it less likely to tear.
Other ways to prevent tearing include:
Labour in water
There are a couple of reasons why this might be, such as the effect of the water itself on your perineum or simply that it is difficult for a caregiver to perform an episiotomy if you are submerged in water.
Give birth in an upright position
Giving birth on your back has been shown to increase your chances of both an instrumental delivery – that’s where a forceps or vacuum is used – and having an episiotomy. Think about delivering your baby in an upright position, such as standing, kneeling or perhaps on all fours. Not only will gravity be on your side for your labour but you’ll also reduce your chances of having an episiotomy.
Use it to create a warm compress to support your perineal area while your baby’s head is emerging. Simply wet the face cloth with warm water, squeeze it out and fold it into a long strip and apply it to the perineal area. The warmth and moistness of the compress will help support and soften the stretching skin as your baby’s head is born.
In the end, an episiotomy is there to help you give birth…