Should I have an episiotomy?
The main purpose of an episiotomy is to avoid tearing the perineum during delivery. There are also several medical reasons to perform an episiotomy, including a breech or very large baby (which might cause extensive tearing), maternal or fetal distress (the baby should then get out as quickly as possible), the need for a forceps-assisted delivery or a mother who cannot push. An episiotomy can also speed up the delivery process. Unless there is a pre-determined reason, the choice about performing an episiotomy is usually made during the second stage of labor, shortly before the baby is delivered.
How is an episiotomy performed?
Before an episiotomy, the woman is given an injection of local anesthesia to numb the area (if you’ve had an epidural, you may not need additional medication), and a surgical cut is made between the vagina and the anus. Episiotomies are measured in degrees, depending on the depth and length of the incision. The most common is a second-degree episiotomy, which cuts through the skin and muscle in a straight line from the rear of the vagina midway to the anus. After the baby is delivered, local anesthesia is re-applied before the incision is sewn up.
How do I recover from an episiotomy?
The area around an episiotomy will be tender and painful for at least a week, depending on the degree of the procedure. Stitches will dissolve on their own and don’t have to be removed medically, but if there are any signs of infection, notify your health care provider. Walking and sitting can be particularly uncomfortable. Applying an ice pack will numb the area and reduce swelling. Pre-soaked witch hazel pads can also be used for soothing and cleansing. Squat when you urinate, and after going to the bathroom, pat dry rather than wipe, or clean the area with a squirt bottle. After about 4-6 weeks, the area should be healed sufficiently for you to have sex again – you might want to use a lubricant to alleviate tightness and tenderness, especially if you’re breastfeeding, which can reduce your natural lubrication.
Is an episiotomy necessary?
For years, episiotomies were a routine part of many vaginal deliveries. Health care providers often believed that the straight surgical incision was easier to fix and quicker to heal than a jagged tear and also felt that the procedure helped prevent potential complications like incontinence and pelvic floor and/or sexual dysfunction. However, recent studies have shown that this is not the case. In 2006, the American College of Obstetricians and Gynecologists issued a statement recommending more restricted use of episiotomy.
What are the risks of an episiotomy?
In addition to the normal discomfort of recovery, potential side effects of an episiotomy include increased bleeding during delivery, infection, urinary/fecal incontinence (depending on the degree of the incision), longer healing time, discomfort during sex and increased chance of tearing during subsequent deliveries.
Discuss your reservations about having an episiotomy with your health care provider before your due date. During the final weeks of pregnancy, you can do perineal massage - massaging the area between the vagina and the anus – on your own to help soften and stretch the tissues and possibly reduce the need for an episiotomy. Kegel exercises, which can strengthen pelvic floor muscles, might also be helpful.
If possible, try an upright position during delivery (as opposed to lying down); this gives gravity more of a chance to do the job and could lessen the need for an episiotomy. Warm compresses are recommended as well. However, you should also realize that an episiotomy may ultimately be necessary for medical reasons and trust your health care practitioner to make the appropriate decision when the time comes.
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