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Episiotomy: The Unkindest Cut of All?




Episiotomy: The Unkindest Cut of All?

An episiotomy is a surgical procedure often preformed during a natural delivery. Here’s what moms-to-be need to know.

What is an episiotomy?

Called “the unkindest cut of all” by opponents, an episiotomy may be the least discussed, but most likely surgical procedure you could undergo in the delivery room.

While everyone knows that there is a possibility that a Caesarean section may be required to deliver a baby, not everyone knows that obstetricians may decide that help a natural birth along with a small incision called an episiotomy. This surgical procedure involves making a cut from the vagina into the perineum (the muscle between the vagina and the rectum) to make a little extra room so that the baby’s head can emerge. “An episiotomy should only be preformed when the baby’s head is stretching the perineum, and the perineum appears as if it will or tear,” says Dr. Nevine El Hefnawi, professor of obstetrics and gynecology at Cairo University.

Dr. El Hefnawi notes that there are two types of incisions: an incision that cuts into the perineum at an angle, and an incision that creates a straight opening from the vagina towards the rectum. Dr. El Hefnawi prefers the straight incision because it heals with much less discomfort, although it carries an increased risk of tearing.

Why is it preformed?

Some people oppose episiotomies, saying that the procedure is often unnecessary and may cause the mother more discomfort than a small tear would. However, many doctors prefer an episiotomy incision to a tear because they say that the neat edges of an incision are easier to repair, while a tear is usually jagged and may be larger than necessary. An episiotomy is regarded as a minor procedure, and it requires only local anesthesia. Sometimes, no anesthesia is needed because, as Dr. El Hefnawi explains, “If the baby’s head is stretching the perineum, an episiotomy can be performed without the patient feeling it, as that area is numb due to the pressure of the baby’s head.” Afterwards, the incision is usually stitched up under local anesthesia.

Although doctors consider the episiotomy to be a minor procedure, many new mothers find the incision quite painful after the birth and an added discomfort while they are recovering from delivery. For expectant mothers getting ready for childbirth, there is good news, however. Some factors determining whether or not you’ll need an episiotomy are in your hands, and even if you do have one, knowing how to take care of your incision can help you ease the discomfort.

What to do before you give birth?

While no doctor will promise that you won’t need an episiotomy, discussing the procedure with him or her before you deliver can help. Some doctors may not be willing to talk readily about the procedure, but pursue the conversation and ask about the steps you can take to try to prevent your having an episiotomy in the first place.

Because an episiotomy is preformed to prevent tearing, if the tissues of your perineum are able to stretch enough, you won’t need one. In general, the episiotomy rate is higher in older women who are having their first child because their muscles have lost elasticity. Therefore, to help build up the elasticity of your muscles, start doing Kegel (or pelvic floor) exercises as early as possible during your pregnancy, especially if you have given birth before and may have weaker pelvic floor muscles as a result. You can do this exercise wherever you are. Simply tense the muscles surrounding the vagina for 10 seconds at a time, as if you are stopping the flow of urine in midstream. Repeat the exercise thought the day. Dr. El Hefnawi also recommends massaging the perineum in the last months of pregnancy.

Caring for yourself after delivery

If you do end up having an episiotomy, knowing how to care for your incision is the best way to avoid unnecessary discomfort. Dr. El Hefnawi notes, “Keeping the incision clean is the most important thing.” Frequent washing with warm water is essential to keep the area free of infection. Some doctors prescribe antiseptic solutions to apply to the wound in an effort to keep it disinfected. Women who have just delivered have a bloody discharge for four to six weeks after giving birth, and you’ll need to change sanitary pads often, at least once every four hours, to avoid any irritation.

“During the first six to eight hours following delivery, apply ice to the area. Afterwards, use heat, “Dr. El Hefnawi recommends. Make sure anything you apply to the incision is very clean. For an ice pack, you can request a sterile surgical glove filled with ice. Dr. El Hefnawi remarks you can apply heat by taking warm baths. Some mothers find sitting on a pillow or an inflated, doughnut-shaped cushion relieves pain. If possible, avoid sitting or standing for long periods, and rest on your side periodically throughout the day. If you suspect infection, make sure to get in touch with your doctor right away.

Also, don’t forget to do your Kegel exercises, which will help your muscles get back into shape. Even if you can’t feel yourself doing the exercises due to numbness in the area, keep doing them. Gradually, feeling will return. “Kegel excercises should be started as early as possible after delivery and continued regularly till the six-week postpartum check up,” says Dr. El Hefnawi. “At that visit, the gynecologist will check the tone of the muscles and tell the patient whether or not the exercises can be discontinued.”

If you are very uncomfortable, due to soreness from stretched muscles and itchiness as your episiotomy incision heals, your doctor may prescribe anesthetic cream to relieve your discomfort. The stitches should dissolve within two weeks, and gradually your discomfort will lessen. In the meantime, don’t forget to take the best care of yourself while you meet the demands of your newborn.



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