Episiotomy

An episiotomy is a surgical incision in the skin during childbirth between the vagina and the anus, called the perineum, designed to accommodate your baby’s head. Immediately before your baby’s head emerges, as your perineum is flattened out, your doctor or midwife decides whether or not more space is needed. If they decide that it is, they then inject you with a local anaesthetic and cut your perineum with surgical scissors.

The most common type of episiotomy in the U.S. is the midline, second degree episiotomy, which runs midway between the vagina and the anus directly. The most traumatic episiotomies are fourth degree, which extend through the rectum and are quite rare. Mediolateral episiotomies are also rare here in the U.S. They are diagonal cuts towards either side rather than direct cuts, and are meant to prevent tearing into the rectum.

American doctors and midwives usually do choose to do episiotomies in order to prevent more significant, structural damage to the tissues of your vagina, bladder, and rectum and to forestall severe lacerations and uncontrolled tears, which are ragged and tough to repair. Episiotomy is also supposed to shorten the pushing stage of labor by about an hour reducing the chances that your baby will suffer from oxygen deprivation. It is valuable when premature or fragile babies need to be spared the pressure of stretching the perineum, the baby is large or breech, the mother is not able to stop pushing, or the use of forceps or a vacuum extractor are called for. It should also protect the baby’s skull and brain from damage as they are thrust against the pelvic floor.

However, many specialists complain that episiotomies expose new mothers to damage of the rectal muscle, infection, and unnecessary pain and blood loss. They argue that tears may heal more easily and with less pain, and that episiotomies do not accomplish all the medical community claims that they do.

Recovering from an episiotomy can be quite painful, though the procedure itself is not after that anaesthetic injection. To minimize the pain and discomfort of those first few days after an episiotomy:

• Use numbing sprays, available in the hospital.
• Apply cold packs. Apply compresses made of cotton pads soaked in witch hazel.
• Sit carefully, on one cheek if possible.
• Walk and do Kegel exercises to stimulate your circulation and speed healing.
• Go for warm soaks in the tub or a sitz bath.
• Expose the wound to air and keep it dry. Blow dry the area after bathing and showering, making sure to keep the blow dryer 12 inches away.
• Whatever you do down there, be gentle and use a lubricant!

If you would rather just avoid the episiotomy altogether, if possible, eat well and do your Kegel exercises, which build up your pelvic floor muscles. Good nutrition helps keep your tissues healthy and elastic, and if you can learn to exercise control over your pushing, you will be able to slow down the second stage of labor enough to allow your perineum to stretch and allow your baby’s head through without an incision.

You should also express your preference to your caregiver. An extra hour of pushing might be a smallprice to pay for increased comfort during your baby’s first days.