Episiotomy Procedures – Advantages & Complications

What is an episiotomy?

An episiotomy procedure is a surgical incision used to enlarge the vaginal opening to help deliver a baby. It’s needed when:

  • Birth is imminent and the perineum hasn’t had time to stretch slowly
  • The baby’s head is too large for the vaginal opening
  • The baby is in distress
  • The mother needs a forceps or vacuum-assisted delivery
  • The baby is in a breech presentation and there is a complication during delivery
  • The mother isn’t able to control her pushing

How is it performed?

If you have already had an epidural, you will probably not need any further anesthetic. If otherwise, it will be necessary to utilize a local anesthetic called a pudendal block in your perineum. The mediolateral cut is angled down, away from the vagina and the perineum, into the muscle.
The midline cut is performed by cutting straight down into the perineum, between the vagina and anus.

How can I prevent the need to have an episiotomy?

The following measures can reduce the need for an episiotomy:

  • Good nutrition–healthy skin stretches more easily!
  • Kegels (exercise for your pelvic floor muscles)
  • A slowed second stage of labor where pushing is controlled
  • Warm compresses and support during delivery
  • Use of perineum massage techniques
  • Avoiding lying on your back while pushing

Can they be harmful?

Episiotomies have the following potential side effects:

  • Infection
  • Bruising
  • Swelling
  • Bleeding
  • Extended healing time
  • Painful scarring that might require a period of abstinence from sexual intercourse
  • Future problems with incontinence

What are some pain relief options for episiotomies and tears?

If you end up having an episiotomy, or any tearing of the vaginal opening, you can try some of the following solutions to help ease the pain.

  • Cold packs on the perineum. Ask your health care provider about special maxi pads that have built-in cold packs.
  • Take a sitz bath–a portable bath that you place over a toilet that allows warm water to cover the wound.
  • Use medication such as Tucks Medicated Pads.
  • Use a personal lubricant such as KY Jelly when you resume sexual intercourse.
  • After using the bathroom, wash yourself with a squirt bottle instead of wiping. Patting dry instead of wiping can also help.

What if I want to avoid having an episiotomy?

In your birth plan clearly state that you do not want an episiotomy unless absolutely necessary. Also, discuss the issue with your health care provider during routine prenatal care.

Want to Know More?

Compiled using information from the following sources:
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 17.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 2.
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