Childbirth is a beautiful experience, but it comes with challenges. Whether through a normal delivery or a caesarean section, every birth requires recovery. Even vaginal deliveries may involve surgical cuts, like an episiotomy, which need proper care and time to heal.
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An episiotomy is a surgical procedure done during childbirth. During vaginal delivery, the obstetrician will make a surgical cut in the perineum – the area between the vagina and the anus. This cut widens the vaginal opening, creating more space for the baby to pass through, making delivery easier. An episiotomy is not done in all vaginal deliveries. In some deliveries, the perineum may tear during the final push as the baby comes out. This is called a perineal tear, and doctors will stitch it after delivery. Since perineal tears can cause unnecessary complications, obstetricians try to prevent them and support the mother through a safer delivery. When the risk of tearing is high, or the baby needs to be delivered quickly, doctors may perform an episiotomy to make a controlled cut instead. Doctors make this cut to avoid severe perineal tears, which can be quite painful and take longer to heal.
Your labour could be progressing just fine, but in the following situations, the doctors have to make the episiotomy for the best outcome concerning you and your baby:
● The baby is in distress (heart rate is too high or too low) and requires to be delivered immediately.
● The vagina needs widening to use medical instruments like forceps or a vacuum to help the baby out.
● The baby is too big for the vaginal opening.
● Baby is in breech position and requires more space to be delivered.
● Active labour has been going on for a prolonged period.
● You are tired of pushing the baby and are losing energy.
● You have health issues that require the labour to be over quickly to avoid complications.
● You are unable to control the pushing. Pushing without contractions can lead to complications for both mother and baby.
So, which is better - A natural perineal tear during delivery or a precise episiotomy to avoid an unnecessary tear?
Doctors prefer episiotomies to avoid unnecessary tearing. Sometimes, the tear can be severe, requiring many sutures and a long recovery. However, research on this suggests natural tears are better than surgical cuts. In 2006, the ACOG - American College of Obstetricians and Gynecologists recommended that doctors don't continue with routine episiotomies unless needed.
Discuss the pros and cons with your doctor during your prenatal check-ups to help you decide what to do if needed. If you feel strongly about it, talk to your doctor and let them know what you prefer. Childbirth involves many factors beyond your control and despite careful planning, unexpected changes can occur, necessitating last-minute decisions.
Episiotomy stitches' healing time depends on the type and degree of episiotomy. There are two types of episiotomy: median (a vertical cut) and mediolateral (a diagonal cut). Perineal tears, on the other hand, are classified into degrees. A first-degree tear affects only the vaginal lining, while a fourth-degree tear extends through the vaginal lining, vaginal tissues, sphincter, and rectum. Some women can experience a fourth-degree perineal tear as well.
After an episiotomy, the perineal area may feel sore and painful for some. The pain can last up to a few weeks. Here are some tips for episiotomy pain management and how to go about the post-episiotomy healing process.
1. Using an ice pack can help reduce soreness and swelling. You can also use a perineal cold pack (an ice pack combined with an absorbent pad).
2. You can take regular sitz baths or sit in your bathtub filled with some warm water. The warmth will promote healing and will also feel very soothing.
3. Use a Peri bottle to squirt warm water on your sutures after using the toilet. A Peri bottle is a small squeeze bottle with a long stem that helps squirt water onto specific areas.
4. Using numb sprays can help alleviate the pain.
5. You can also consult your doctor and use over-the-counter painkillers. Getting your doctor's approval is very important as the medication can reach the baby through breast milk.
6. Witch hazel can offer good relief. You can use witch hazel pads with your regular pad and enjoy some relief.
7. Invest in a doughnut pillow – a pillow that will have a hole in the middle like a doughnut. Sitting on this pillow will remove pressure from the perineal area and enable you to sit without any discomfort or pain.
8. Lay on your side as much as you can. Laying on your back will increase the pressure on the perineum.
9. Refrain from sexual intercourse, or inserting any sanitary products like tampons into your vagina.
10. Wait at least six weeks for a physical examination by your doctor and their approval before resuming sexual intercourse.
Episiotomy is a common procedure done in most vaginal deliveries. It may be uncomfortable and painful at times. If you notice the following, you should consult your doctor immediately:
● Pain intensifies or worsens instead of getting better.
● Pus or smelly discharge comes from the incision.
● The area around the incision is red or swollen.
● Bleeding from the incision.
● Fever, chills, body aches and fatigue.
Episiotomy is done only when necessary and as a precaution. The body naturally adapts to childbirth, and the extent of tearing cannot always be predicted. In some cases, the cut may be larger or smaller than required. It's best to discuss with your doctor and make an informed decision based on medical advice.
Signs of a normal recovery after an episiotomy include mild irritation around the sutures, pain and soreness for a few days to weeks, discomfort when sitting on hard surfaces, and initial skin healing around the sutures.
Squirting warm water using a Peri bottle, sitting in a sitz bath and the use of a perineum pad can help soothe the discomfort. If needed, with your doctor's approval, you can also use over-the-counter painkillers to manage the pain.
After an episiotomy, you can start slow walking and moving around within a few days. For more strenuous physical activities, you must wait at least 6 weeks post-delivery.
