Episiotomy

14April 2023

What is Episiotomy?

An Episiotomy is defined as the surgical incision made in the perineum during labour. The perineum is the tissue between the vaginal opening and the anus. The incision made on this tissue widens the opening of the vagina, thereby allowing the baby to come through more efficiently.

The skin of the perineum is stretchable; however, despite that, it can tear, especially in women who are undergoing their first delivery.

Massage the perineum in the weeks leading to the delivery to reduce risks of Episiotomy drastically.

Why is it needed?

In some cases, Episiotomy helps in preventing a severe tear while in other cases, it facilitates a quicker delivery of the baby.

At one point of time, Episiotomy used to be a routine part of childbirth through vaginal delivery. However, now even though it is no longer a regular requirement, but in some cases, it is needed. Statistically speaking, 9 out of 10 first-time mothers will have some type of Episiotomy, graze or tear during vaginal birth. If your doctor feels that you need to have an Episiotomy they will recommend it to you and plan for it accordingly if you give the consent.

Some situation when an Episiotomy becomes essential includes:

If the mother is trying to give birth for several hours and is now tired of pushing
If the baby is in either a breech position (feet first) or a transverse position (shoulder first).
If the mother has a severe health condition, like heart disease, the delivery should be sped up to reduce further health risks.
If the baby’s heart rate pattern is abnormal during the delivery.
The mother needs an operative vaginal delivery. This type of delivery is performed using forceps and vacuum, and an Episiotomy prevents tears that affect the anal muscle (third-degree tears)

How is an Episiotomy done?

An Episiotomy is a simple procedure. You won't feel anything when the incision is made or repaired as a local anaesthetic will numb the area around the vagina.

During an Episiotomy:

You lie on the bed and your legs and feet are supported.
Local anaesthetic will be injected into your perineal skin and the muscle (if you have not received any anaesthesia already) – this will numb the tissue before the doctor makes the incision.
At the pushing stage of the labour (the second stage), when the baby’s head stretches the vaginal opening , an Episiotomy incision is made. This is done using scissors or scalpel.
After the baby is delivered, the doctors will inspect the incision to check for any further tearing.
The perineal tissues and the muscle will be closed using stitches. These are self-dissolving stitches(they dissolve over time.)

Your doctor may choose the type Episiotomy for you based on your body’s condition. The two types of Episiotomy incisions are:

Midline (median) incision:
- It is done vertically in the centre of the vaginal opening down to the anus.
- It is less painful
- It is less likely to result in long term problems during sexual intercourse.
- Has less blood loss.
- It is easier to repair, with the only risk being that there arehigher chances of deep perineal tear.
Mediolateral incision:
- This incision is done at an angle. The incision starts from the middle of the opening in the vagina and extends upto the buttocks. The angle of the incision is 45 degrees.
- Lower risk of deep perineal tear.
- It ismore painful
- It is more challenging to repair
- There are higher chances of long term discomfort during sexual intercourse.

The severity of an Episiotomy:

Based on the severity and the extent of the tear, Episiotomy can be classified into the following types:

First degree: In this, there is only a small tear and it involves the vagina lining
Second degree: This extends through the vagina lining and the vaginal tissue. The second degree is most commonly observed in pregnancies.
Third degree: This effects the vaginal lining, a portion of the anal sphincter and the vaginal tissues
Fourth degree: This has the highest severity. It involves the vaginal lining, the anal sphincter, rectal lining, and the vaginal tissues.

Recovering from an Episiotomy

Usually, Episiotomy cuts are repaired within an hour of a baby’s birth. Occasionally the cut may bleed quite a lot initially; however, this is stopped by applying pressure and with stitches. The stitches used to repair the Episiotomy are self-absorbing, and they generally heal in about a month from the birth. Your doctor will tell you about the activities you should avoid during the healing period.

Pain-relieving creams or ointments aren’t useful for Episiotomy wounds. However, you can take prescription medications or use an over the counter pain reliever or stool sample.

When you are healing the discomfort will slowly go away.

Alert: Consult your doctor if:

The pain intensifies in the perineal area.
You develop a fever greater than 100 degrees Fahrenheit.
Wound produces a pus-like discharge.
The Episiotomy site starts bleeding.
There is foul-smelling vaginal discharge.

Exercises that can help your recovery

Strengthening the muscles around the vagina and anus is good for proper healing. You can do this by pelvic floor exercises as this will reduce the pressure on the cut and surrounding tissue.
Pelvic floor exercises involve squeezing the muscles around your vagina and anus as if you are trying to stop yourself from going to the toilet or farting.
How to cope with the pain of Episiotomy?
Some pain is normal after an Episiotomy.
Recommended:Painkillers like Paracetamol could be taken to alleviate the pain and they are considered safe to use if you’re breastfeeding.
Recommended after consultation with doctor:Ibuprofenis also considered to be safe to consume while you are breastfeeding; however, consult your doctor before taking it.
Not Recommended: Aspirin is not recommended as it can be passed on to your baby through your breast milk.

If you are unsure about the right medication, always consult your doctor.

For severe pain, you may need to take more potent prescription-only painkillers such as codeine. However, such a strong prescription-only medication can affect your ability to breastfeed.

Non-Medicinal Solution:Place an ice pack or ice cubes wrapped in a towel on the cut. Applying the ice directly on the skin could be damaging.

You can also help the healing process by exposing the stitches to fresh air. Take off your underwear and lie down on a towel or a bed. You should lie down for around 10 minutes once or twice a day.

Usually, the pain after an episiotomy doesn’t last longer than 2 to 3 weeks. If the pain lasts longer than that, consult your doctor.

Going to the toilet after an Episiotomy

Always keep the cut and the surrounding area clean to prevent infection. When you go to the toilet, pour warm water over your vaginal area to rinse it. Pouring warm water

To ease the discomfort while you pee, you may pour warm water over the outer portion of your vagina.

To reduce the stinging sensation while peeing, try squatting over the toilet rather than sitting on it.

When you are pooing, it would be advisable to place a clean pad on the cut and press gently. Putting the clean pad will help relieve pressure on the cut.

While wiping your bottom, gently wipe from front to back. This simple act of hygiene will protect you from the bacteria in your anus.It would be best if you protected yourself from the bacteria as it might infect the cut and the surrounding tissue.

If pooing is particularly painful, you can take laxatives to help. This type of medication is generally used to treat constipation and makes poo softer and more comfortable to pass.

Potential risks of getting an episiotomy

Infection:If you have had Episiotomy, chances of getting an infection are high. Always be on the lookout for any signs showing that the cut or the surrounding tissue has become infected. These signs include:

Red, swollen skin
Discharge of pus or liquid from the cut
Persistent pain
An unusual smell

In case of any of these signs seek your doctor’s consultation to know about the necessary treatment.

Pain during sex: While giving birth if you had a tear or an Episiotomy, you may experience pain while having sex in the first few months.
Faecal incontinence
Midline Episiotomy may put you at risk of a fourth-degree vaginal tearing. This tearing extends through the anal sphincter and into the mucous membranethat linethe rectum.
In some cases, excessive, raised or itchy scar tissue may form around the place where a tear happened or where an Episiotomy was done. If scar tissue is causing you a problem, consult your doctor.

Can I avoid the need for an Episiotomy?

If you are anxious about an Episiotomy and want to avoid it, the first thing to do would be to consult about it with your health care provider.

In the weeks and months leading up to the pregnancy, there are a few things that you can do to avoid an Episiotomy (there are some steps that you can follow during the pregnancy too).Following are some such steps:

Good and proper nutrition: This will make your skin healthier, and healthier skin stretches more easily.
Exercise: You can do Kegel exercises to strengthen your pelvic floor muscles
Massage: You can get perineum massage
Avoid lying on your back while pushing.
Try to slow down the second stage of labour so that the pushing is more controlled.

Reference:

By -
Dr. Ruchika Singh

14-April-2023

Episiotomy

Share this post