The period leading up to childbirth can be stressful for pregnant women, and having a delivery plan is vital. One aspect of delivery that may arise is the possibility of an episiotomy procedure being performed. The need for this procedure is based on the assessments made by the consulting obstetrician or gynaecologist during prenatal visits or at the time of delivery. An episiotomy is considered a way to ease childbirth, thus bringing down the risks to the health of the baby and mother. It is very important to know about the procedure and its purpose before you consent to it. The episiotomy procedure is explained in detail in this blog, providing a comprehensive guide for expectant mothers.
Episiotomy is an approach adopted by the healthcare provider to ease childbirth. This is a procedure wherein a small cut or incision is made in the perineum, which is the area between the vaginal opening and the anus. This incision increases the width of the vaginal opening, which aids the baby to come out quickly and with ease. This is not a common approach, though, as natural tearing of the perineum is preferred during childbirth. However, in certain conditions, this procedure is recommended to protect the baby and mother from complications arising from childbirth.
Your healthcare provider might suggest this small surgical procedure based on their inferences or assessments from prenatal checkups or during labour. Following are the situations that require an episiotomy to be performed:
● The baby is large and there is a risk of larger perineal tissue tears.
● Fetal distress is observed during delivery and the baby needs to be delivered quickly.
● The baby is in a breech position, which makes the delivery procedure difficult.
● The baby’s shoulder is trapped during delivery.
● Delivery takes place before the pregnancy term is complete.
● The delivery process takes a long time, and the mother is exhausted from or unable to control pushing.
In short, these are the various reasons for an episiotomy to be performed during childbirth. These situations demand the need to enlarge the vaginal opening via incision.
It is essential to understand the steps involved in the episiotomy procedure to overcome worries. This procedure has well-defined processes, as explained below:
● The extent of the incision will be determined by the healthcare provider based on the mother’s condition.
● Once the type of incision is decided, the perineal area will be numbed. This is done by giving a local anaesthetic, provided no spinal anaesthesia was administered.
● The anaesthetic will be administered under the guidance of a qualified anaesthesiologist.
● As the labour progresses to the second stage, when the baby pushes against the perineum, the practitioner performs the incision.
● After the baby, along with the placenta, is pushed out, the incision is stitched using soluble stitches.
● The healthcare provider will observe for any complications and provide immediate attention.
The healthcare providers will always analyse episiotomy vs. natural tears in every case. This procedure is done only in extreme conditions to prevent the risks of severe perineal tears. Even though postpartum discomfort as well as pain makes the birthing process difficult, this procedure helps in quick and safe delivery.
There are two types of episiotomy incisions: a midline incision and a mediolateral incision.
This is done by performing a straight cut through the midline from the vaginal opening to the anus. This is a bit risky, as it might tear the anal sphincter.
Here, the cut is made at an angle from the vaginal opening. This is usually done when the baby is not in a good position. This kind of cut doesn't impact the anal sphincter.
The severity of the episiotomy procedure is determined based on the extent of the cut performed during the procedure. This includes:
● First degree: Indicates only a small tear that heals very fast.
● Second degree: This is a slightly deeper tear impacting the muscles of the perineum.
● Third Degree: This tear involves vaginal tissues and lining.
● Fourth Degree: This is the most severe type of tear that affects the rectum, vaginal lining, vaginal tissues and anal sphincter.
The aftercare and recommendations will be made based on assessing the extent of the cut during the episiotomy.
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It is important to understand the risks associated with the episiotomy procedure. The various complications that may arise may include:
● Experiencing heavy and extensive bleeding
● Blood collection in the area of the incision
● Infection around the stitches
● Pus or discharge from the cut
● Pain and discomfort
● The incision does not heal
● Urinary or fecal incontinence
● Development of swelling or scars around the incision
● Experiencing dyspareunia or painful sexual intercourse many months after the delivery
It is important to be informed and know the potential risks. If you experience any of these after the procedure, seek medical assistance immediately.
Episiotomy is a surgical procedure, and one can experience discomfort accompanied by soreness or swelling for a few days. Hence, proper recovery depends on the aftercare one gets.
During the recovery period, it is essential to maintain good personal hygiene. Do not exercise until complete recovery is achieved. To manage pain and swelling, use the prescribed pain medication and apply ice packs as instructed by your medical practitioner. One can recover quickly by resting, eating a fibre-rich diet, and drinking lots of fluids.
It is also extremely important to seek immediate medical attention if there is a fever, heavy bleeding, severe pain felt in the lower abdomen, or a foul-smelling discharge.
Understanding the episiotomy procedure empowers you during childbirth. By following your medical team's guidance and managing discomfort with prescribed methods, you can navigate this experience with greater confidence. Remember, open communication with your healthcare provider is key to ensuring your comfort and understanding throughout the entire process. By staying informed and communicating openly, you can approach delivery with confidence.
No. An episiotomy is not always required during childbirth. It is needed only in cases where there is a potential threat to the baby or the mother during vaginal delivery.
The mediolateral incision and the midline incision are the two different types of episiotomy incisions.
Episiotomy is done to enable quick delivery and prevent complications from severe perineal tear. The sharp pain during incision and postpartum discomfort could affect the overall birthing experience.
