An episiotomy is a surgical incision used to enlarge the vaginal opening to help deliver your baby.
What are some circumstances that would require an episiotomy?
An episiotomy may be needed for any one or more of the following reasons:
- Birth is imminent and your perineum hasn’t had time to stretch slowly
- Your baby’s head is too large for your vaginal opening
- Your baby is in distress
- You need a forcep or vacuum assisted delivery
- Your baby is in a breech presentation and there is a complication during delivery
- You aren’t able to control your pushing
How is an episiotomy performed?
If you have already had an epidural, you will probably not need any further anesthetic. Otherwise, a local anesthetic in your perineum, known as a pudendal block, will be necessary.
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 are preventive measures to lessen the chances of needing this surgical incision:
- 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 perineum massage techniques
- Avoid lying on your back while pushing
Can episiotomies be harmful?
The following are potential side effects of an episiotomy:
- Extended healing time
- Painful scar which may require a period of abstinence from sexual intercourse
- Future problems with incontinence
What are some pain relief options for episiotomies and tears?
If you have an episiotomy or tearing you may want to try some of the following 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. Portable baths that you place over a toilet to let warm water cover the wound.
- Use medication such as Tucks Medicated Pads.
- Use a personal lubricant, such as KY Jelly when you resume sexual intercourse.
- Wash with a squirt bottle instead of wiping after using the bathroom. Patting dry, instead of wiping can also help.
What if I want to avoid having an episitomy?
Clearly state in your birth plan that you wish an episiotomy not be done unless absolutely necessary. Also, speak to your health care provider about an episiotomy during routine prenatal care.
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.
American Pregnancy Association, http://www.americanpregnancy.org