So, you are pregnant and you are considering an episiotomy, but you aren`t really sure. You have so many questions and a lot of worries regarding this procedure. “How long does it take for an episiotomy to heal,” “What is an episiotomy” or “why is it done?” – these are only a few of the questions that give you headache sometimes.
So, you are pregnant and you are considering an episiotomy, but you aren`t really sure. You have so many questions and a lot of worries regarding this procedure. “How long does it take for an episiotomy to heal,” “What is an episiotomy?” or “Why is it done?” – These are only a few of the questions that give you headache sometimes.
Table of Contents
- 1 What Is Episiotomy?
- 2 Why to do an Episiotomy?
- 3 Is It Painful to Do Episiotomy?
- 4 Traditional Approach vs. Modern Approach
- 5 Complications of Episiotomy
- 6 Role of Warm Compresses and Massage
- 7 How Long Does It Take for an Episiotomy to Heal?
- 8 Communication with the Doctor
- 9 Preventive Measures
What Is Episiotomy?
Episiotomy represents the incision of the perineum – the tissue between the vaginal opening and the anus – and posterior vaginal wall made in the second phase of birth by the obstetrician in order to widen the vaginal opening, thus facilitating the release of the fetus. With a length of a few centimeters, it can be performed on the median line (towards the anus).
Why to do an Episiotomy?
These procedures might be required in some cases: if the child`s shoulders are too wide and he doesn`t fit trough the birth canal, if the heart rate of the baby drops and delivery is accelerated by making a cut into the perineum, or if the baby is being delivered by vacuum suction or forceps.
Doctors prefer episiotomy because it`s easier to heal than a rupture caused by the baby`s passage through the vaginal canal. Therefore, episiotomy helps the baby come into this world and avoids ruptures, which has uncontrolled consequences.
Is It Painful to Do Episiotomy?
This procedure is very little painful (or not painful at all). Practically, using epidural anesthesia explains the absence of pain. In the case of natural birth (without epidural anesthesia) – there`s a small local incision made that gets rid of any pain during the incision. After birth, the doctor stitches the place of episiotomy, of course, after the local anesthesia was performed.
An episiotomy that hasn`t healed well or which wasn`t properly stitched may leave scars more or less painful or may make sexual contacts difficult. The issue can be solved surgically by resuscitation of the incision.
Traditional Approach vs. Modern Approach
The practice of routine episiotomy has become increasingly controversial in recent years. Traditionally, doctors used this procedure as a prevention method, trying to avoid uncontrolled perineal tears, especially the anal sphincter and rectum. Another reason is to shorten the expulsion, reducing the neonatal trauma.
Still, over time, these reasons have been challenged. Therefore, a number of studies have shown that natural fractures are less severe, heal as fast or even faster and with fewer complications than episiotomy wounds. Thus, indications were restricted gradually being replaced by various methods aimed to prevent perineal laceration at birth: Kegel exercises practiced during pregnancy, perineal massage started at 5 – 6 weeks before birth, child effortless expulsion, etc.
Arguments in Favor of Episiotomy
- Shorten delivery.
- It prevents uncontrolled and extensive perineal tears.
- Protects against urinary and anal incontinence (due to trauma brought on the perineal muscle and ligament structures during expulsion).
- Prevents pelvic flood relaxation.
- Subsequent Local discomfort.
- Possible infectious complications of the episiotomy wounds.
- Pains during intercourse.
- Sometimes difficult healing.
There Are Situations when an Episiotomy Is Indicated
- Increased sizes of the baby.
- Abnormal presentation, when the doctor needs more space to work with the fetus.
- Using the assisted birth procedures, when the doctor needs more space to insert the forceps and vacuum.
- Fetal distress requiring urgent delivery.
Presently, is accepted an incidence of episiotomy of maximum 30% of the total natural births, the objective being to decrease this percentage in time. – More info!
Complications of Episiotomy
- Risk of infection.
- Local inflammation and bleeding.
- Persistent pain.
- Longer healing period.
- Increased discomfort in resuming sexual life.
What the doctor cannot promise you is protection on the short or long term against perineal ruptures and urinary incontinence. Perineal ruptures represent a risk when natural births are concerned, but they aren`t a certainty (a risk that increases when labor is induced and the baby drops more rapidly, not leaving enough time for the perineum to adjust). Pregnant women need advice when it comes to episiotomy. Is it a viable option to replace the possibility of a perineum rupture with the certainty of a surgical incision? Is it truly an episiotomy preferred instead of spontaneous perineal rupture?
Maybe the answer it surprising, but studies show that the women who suffered spontaneous ruptures during delivery have healed in the same period of time or less, and have suffered less complications compared with the ones who were subject to an episiotomy. Also, recovery after this procedure is most of the time painful and difficult. The cut is usually bigger and deeper than the spontaneous rupture would have been.
When it comes to advice for pregnant women, sometimes more plastic explanations are more useful, so it would be best to try and imagine a piece of clothing. If you grab it with both hands and try to break it, the piece of clothing will resist, and will most likely stretch without breaking. However, if you take a scissors and make a little cut and then try to break it, the material will easily break. It`s the same with your skin; this would have to be just as resistant and elastic like the piece of clothing that we just imagined. However, once cut and then being the subject of a high pressure, it will break and the rupture will become deeper.
Most of the time, such a routine procedure will contribute to the doctor`s comfort. He`ll often prefer to stitch a straight cut than a ragged rupture.
Role of Warm Compresses and Massage
During the second phase of labor – when you push – the doctor may apply warm compresses on the skin between the vaginal opening and anus, which would soften the tissue and prevent its collapse.
Although the beneficial role of this method is well proven, some physicians might perform you perineal massage in this area during labor or even recommend to practice it on your own at home before childbirth – although you shouldn`t really do it if it may start to feel uncomfortable. – Read this!
You should start by thoroughly washing your hands with warm water and soap, and be certain you have your nails cut. Then introduce your thumb (well lubricated) in your vagina and exert a pressure for 1 – 2 minutes on the rear wall of your vagina. Gently massage the lower part of the vagina. Repeat this procedure once per day for 10 minutes until childbirth.
How Long Does It Take for an Episiotomy to Heal?
If you experienced an episiotomy or perineal tear during birth, the injury may hurt for a few weeks – especially when you walk or sit upright. If the incision or laceration were large, the sensitivity may last even longer. The stitches used will be defused by themselves.
You can help the healing process by:
- Apply cold compresses to the affected area.
- When urinating, put a bit of warm water on your vulva and wash it with a jet of water.
- During a stool, you can prevent pain if you press firmly over the scar with a clean pad.
- Sit carefully, tensing your buttock muscles as you let yourself down when sitting down. Sit on a pillow or a seat, rather than a hard chair.
- Use the medication recommended by your obstetrician. Analgesic creams or ointments haven`t been proven useful.
- Take into consideration alternative treatments, like lavender. If your doctor will agree, you may use a few drops of lavender essential oil in your bath water or you may apply it directly on the scar.
While the wound heals, expect for the discomfort to lessen gradually. However, if the pain intensifies, fever occurs or the scar produces a fluid, immediately get in touch with your obstetrician, because these might be symptoms of infection. – Check this out!
Communication with the Doctor
If the future mother is concerned regarding the episiotomy procedure, she should share her worries with her doctor during her prenatal visits and before childbirth. No matter the case, it`s essential for the mother to be as relaxed as possible during birth. If her vaginal tissues are strained, the child will be born heavier. Therefore, it`s very important to establish with your doctor which are the best options for childbirth, for both the mother and baby.
Research shows that massaging the perineum may reduce the necessity of such a procedure. Massage can be an option if you want the perineum to be more flexible, so when the baby is delivered, it will be more prone to stretch than break.
Perineal massage is made as it follows:
- Take a warm bath.
- Massage the region around the vagina`s opening in a gentle manner for around 10 minutes (start around the week 34).
Note: This will not guarantee a tear-free delivery or that you`ll manage to avoid an episiotomy, but it will definitely help.