During your pregnancy, you’ve probably come across the term episiotomy. Or you’re clueless about what an episiotomy is.
Let’s face it; you don’t want to even think of having your vagina cut. Unfortunately, it’s something you need to know about before you go into labor.
An episiotomy isn’t something you can plan for. So you may be wondering why you need to learn about an episiotomy in pregnancy.
The reason is informed consent.
An episiotomy is a medical procedure that often has to be performed in emergency situations or at the height of labor.
Both of these are situations which leave you unable to think straight or take important information on board.
If you know about them beforehand, you are more likely to understand what is happening and the effect it may have on you.
I’ve created this guide to give you all the information you need to know before baby arrives. There is quite a lot to take in, especially if your head is spinning with birthing info.
Pin it now so you can refer to it later in your pregnancy. Also, remember to share with your pregnant friends who will find it useful.
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Episiotomy Guide For Birth
What is an episiotomy?
An episiotomy is a medical cut that made on the perineum or the area of skin and muscle between your vagina and anus.
This area of skin can often restrict the amount of space a baby has or can slow the delivery.
The cut is made during the pushing stage of labor as your baby’s head starts to crown. Ideally, the damage from an episiotomy should be equal to a second-degree tear (vaginal skin and muscle only).
Your caregiver repairs the wound with stitches after your baby is born.
Types of Episiotomy Cut
There are two types of episiotomy: midline and mediolateral. Each has its benefits and drawbacks.
This type of cut is made straight down toward the anus (between 12 and 6 on a clock). This style of episiotomy is standard in the USA and Canada.
A midline episiotomy is often preferred as it is easier for doctors to perform and repair. This type of cut results in less bleeding, pain, and pain during sex.
The main risk of a midline episiotomy is extended tearing. If you continue to tear even after this type of cut, it can reach into your anus. This damage can cause life-changing medical problems which may leave you unable to control your bowels.
Your caregiver makes this cut at a 45-degree angle towards the butt cheeks. This type of episiotomy is typical in Europe.
The main advantage of this type of cut is avoiding any cut or tearing to the anus.
The drawbacks of this type of episiotomy are that it takes greater skill to repair, which may make healing more uncomfortable.
Reasons for episiotomy
In the 70s and 80s, episiotomies were a routine part of a vaginal delivery. Fortunately, that practice has long gone. However, an episiotomy can provide some benefits during birth.
We’ve already discussed that the perineum can slow delivery or reduce the space baby has. These are situations where you may need either of these:
Delayed second stage
The second stage is when you dilate to 10cm, and your baby is ready to be born. This part is when you start to push with each contraction. The second stage can last a long time if your perineum is holding your baby back. This delay usually happens if your perineum is notably thick or muscular.
An episiotomy releases the resistance on babies head and provides more room for baby to be born. In this situation, to justify an episiotomy then your baby is distressed, or you have been pushing for at least an hour.
Passing over the perineum naturally can slow down the delivery. Some babies can’t cope with this stage, and their heart rate drops dangerously low. An episiotomy can speed up the delivery, to prevent further distress to your baby. This intervention can prevent your baby requiring resuscitation if they have only suddenly become distressed.
The perineum stretches a lot as your baby’s head moves down the vagina. If this stretching happens too quick, the perineum can’t cope and begins to tear. You can sometimes see this happening on the outside. An episiotomy may be performed to control how far this tear extends. Your doctor will do this if a tear is reaching up to the urethra (the hole you pee from).
If you need help to deliver your baby with forceps or a suction cup, your doctor will usually perform an episiotomy. The reason is that your perineum has less time to stretch and is more likely to tear. The doctor should assess your perineum to keep damage to a minimum.
This is an emergency situation where your baby’s head delivers but the shoulders stay stuck in the pelvis. An episiotomy won’t help deliver the shoulders, but it can make room to perform maneuvers that will.
There are some medical conditions (often heart-related) that can limit how much pushing you can do in labor. Pushing puts a lot of strain on the body, especially if you are doing it for a long time. An episiotomy can speed up the delivery to help you achieve a vaginal birth.
The benefits of an episiotomy should be weighed up against to risk of tearing. An episiotomy should never be carried out for convenience sake as there are a lot of potential risks.
Although an episiotomy can be used to control the extent of a tear, it can make it worse. In fact, most 3rd or 4th-degree tears are caused by an episiotomy that extends. This means that the episiotomy causes more damage than without one.
An episiotomy means a wound that requires healing from an already tired postpartum body. The risks include increased risk of pain, bleeding, infection, nerve damage, immobility, and constipation. Severe health effects include anal fistulas or incontinence.
Having an episiotomy performed without consent can trigger mental trauma. This trauma can worsen if there are long-term health issues that have resulted from this procedure.
Any vaginal damage will weaken that area for future births. That means you are at higher risk of tearing and requiring stitches. If an episiotomy extends to cause anal trauma, you may be advised to have a C-section for future babies.
It’s common for an episiotomy to result in reduced sensation or increased pain during sex. Reluctance and fear to have sex can lead to massive strain on relationships.
The cost of long-term health conditions which require lifelong treatment can cause a severe financial strain. Consider the cost of medical bills and therapy. Therefore make sure you have good health insurance in place before you have your baby.
You may have strong feelings about avoiding an unnecessary episiotomy or requesting one during delivery. It’s a procedure that is still carried out in around 12% of vaginal births in the USA.
I would highly recommend having a discussion about episiotomy with your caregiver. Ask them how often they perform them and under what circumstances.
You may also want to know what they do to prevent tearing during delivery. Good perineal support and communication during crowning can reduce tears. Doctors are more likely to perform an episiotomy than a midwife.
A routine episiotomy (without justified need) is not an evidence-based practice. The ACOG and World Health Organization (WHO) advise against them.
There is also no benefit of a planned episiotomy if you had a tear or episiotomy during a previous birth. Although, as the skin is weaker in this area, you’re at higher risk of tearing again in the same place.
Episiotomy vs. Tearing
Most normal vaginal deliveries that are progressing well do not require an episiotomy.
Without an episiotomy, the risk is that you may naturally tear instead. Although, if you have an episiotomy you may still tear.
If there is no good reason for an episiotomy, then it’s likely you will have similar or lesser damage than an episiotomy would cause. Most tears don’t require any stitches at all.
A tear is much more likely to result in quicker healing and less blood loss. A ragged tear can be more difficult to repair the straight cut of an episiotomy.
Current evidence favors natural tearing over an episiotomy for healing, blood loss, and long-term damage unless there is a valid medical need.
The first step of an episiotomy should always to obtain consent from you. This is a legal requirement, not a guideline. The details of this may depend on the urgency of the situation. An episiotomy should never be performed without your knowledge or consent, regardless of the need.
Sometimes a birth situation can be hectic, and it can be difficult to take things on board. Discuss with your birthing partner that they should also be made aware if an episiotomy is to be performed. Let them be your advocate if one is about to be done without good reason.
An episiotomy is a quick procedure taking about a minute or two to complete. This is what will happen.
- Your caregiver obtains consent from you (with justification for need).
- You will have an epidural top up or a local anesthetic to numb your perineum. This takes a few minutes to work.
- Your caregiver inserts two fingers between your perineum and your baby’s head, preventing injury to your baby.
- The episiotomy is performed at the height of a contraction, so only skin and superficial muscles are cut.
- An incision is made in one firm cut about 4-5cm long.
- Your baby’s head will deliver, followed by the body
- After delivery, your cargiver will ask to carefully inspection your vagina further tearing.
- Your caregiver will then repair the episiotomy and any additional tearing with stitches.
Your vagina will feel like its gone through the wars after delivery. It will fell bruised and swollen, and your stitches may feel sore and tight.
It can take anything from a week to a month for your perineum to heal. Any longer than this and it’s best to seek medical advice for a review.
Check out my guide to caring for your vaginal stitches. You find all you need to know about hygiene, pain management, comfort, intimate issues and seeking advice. Plus I’ve recommended some products you can use at home to provide relief and prevent infection.
Always report any concerns or signs of infection to your caregiver. These are your red signals:
- Excessive swelling
- hot to touch
- offensive smell
- increasing pain (even with pain relief)
- fever symptoms
If you experience any of these symptoms, seek a medical review ASAP. Untreated postpartum infection will cause you to become very unwell and be admitted to hospital.
Related: Postpartum Recovery Essentials
Can I prevent an episiotomy?
When your labor is progressing normally there is no indication to do an episiotomy. Good position and communication with your caregiver can reduce tearing. Check out my guide on vaginal tearing during labor for more tips on preventing cuts and tears.
Does and episiotomy cut hurt?
Your caregiver requires two things before they do an epsiotomy: your consent and adequate pain relief. This may be from your epidural or local anesthetic. It’s a quick procedure your caregiver does at the point when your baby’s head is crowning. As the periniuem stretches is causes an intense burning snesation known as the ‘ring of fire’. You’ll probably be more focused on that sensation and be unaware of an episiotomy.
When will I be able to exercise after an episiotomy?
It’s always best to wait for medical approval before starting postpartum exercise. Most doctors approve exercise, when are fit and well, at 4-6 weeks after birth.
Exercise will help strengthen your pelvic floor muscles. You should introduce Kegel exercises to target the muscles that have been weakened by pregnancy and birth.
Will need an episiotomy for my next birth?
A planned episiotomy is not necessary for past tearing or episiotomy. However, you are at higher risk of tearing again in these areas as they are weaker. It’s unlikely any tearing will extend beyond your scar tissue. This means if you do tear it’s likely to be equal to or less than a previous cut or tear.
If you had a previous 3rd or 4th-degree tear with extensive damage, it’s advisable to consider a planned C-section.
Will I be left with a scar?
An episiotomy will leave a scar on your perineum. If repaired well it should heal well and become virtually unnoticeable. It’s important to contact your caregiver for a review if your scar has loss of sensation, constant pain or is painful during sex.
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