Episiotomy – Frequently Asked Questions
As a deliberately performed surgical cut, episiotomies unavoidably cause a significant amount of trauma to a woman's genital area, and can even increase the chance of subsequent complications. So whether you are expecting, or you have recently had an episiotomy during childbirth, you need as much information about episiotomies as possible. This will help you understand the procedure, why it may be necessary, and how you can aid recovery.
What Is An Episiotomy?
An episiotomy is a surgical cut made to the perineum (the area of skin and muscle between the anus and vaginal opening) during a vaginal delivery. This procedure is not carried out on all mothers, but only on those who require their vagina to be extended more fully, helping to make the birth easier.
How Is An Episiotomy Performed?
Before an episiotomy is performed, a woman will be given local anaesthetic to numb the area (unless an epidural has already been carried out). A doctor or a midwife will use surgical scissors to make a diagonal cut which runs down from the back of the vagina and out to one side. Called a 'mediolateral episiotomy', the diagonal direction of the cut is important to help reduce the risks often associated with this type of procedure (such as severe tears).
Are Episiotomies Always Necessary?
Episiotomies used to be performed regularly in the UK, as doctors believed the procedure helped to decrease the occurrence of post-partum complications such as urinary incontinence. However, this opinion has now changed, and episiotomies are only carried out in certain circumstances. These include:-
- If an assisted birth is necessary (such as forceps or suction);
- If it is a breach birth;
- If the baby's shoulder gets stuck behind the pubic bone;
- It is a long labour and the mother is exhausted;
- The mother has a health condition which makes a long labour dangerous (such as heart disease);
- The baby is experiencing 'foetal distress' (whereby their heart rate either significantly increases or decreases);
- The mother suffered extensive damage/scarring to her perineum from a previous birth.
Can I Avoid An Episiotomy?
There are several things you can do during your pregnancy to help reduce the chance of an episiotomy being necessary. Firstly, eat a healthy balanced diet and drink plenty of water. This will make your skin healthier and increase elasticity, helping your perineum to stretch more readily. Secondly, six weeks before your due date you (or your partner) should start massaging your perineum regularly. Again, this will make the area supple.
During the birth itself, a slow and controlled delivery will help the vagina and perineum to stretch gradually, without the need for sudden intervention. Furthermore, it can be useful for a woman to change position frequently, while avoiding giving birth while lying on your back with your feet in stirrups will reduce the chance of tearing.
Lastly, if you know you do not want to have an episiotomy, discuss this with your obstetrician well before you are due. It is possible to include this wish into your birth plan, with instructions only to perform an episiotomy if it is strictly necessary.
How To Recover From An Episiotomy?
After the baby has been delivered, a mother who has undergone an episiotomy should have her injury sutured with dissolvable stitches. Medical staff should then advise you on how to help your episiotomy heal, which will include:-
- Maintaining good hygiene;
- Eating a balanced diet and drinking plenty of water;
- Doing pelvic floor exercises;
- Exposing the stitches to air regularly (around 10 minutes per day);
- Applying ice to the area to reduce swelling;
- Taking pain relief (such as paracetemol, which can be used while breast-feeding).
If your episiotomy is still causing you pain and discomfort after six weeks, seek medical advice as there may be some additional complications.
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