EP 27: Every Women's Worst Fear: An Episiotomy

Updated: Feb 4


Let's discuss this, let's clear the air, and let's remove some fear.


PODCAST: EP 27

What is an Episiotomy?


An episiotomy is often a woman's worst fear when facing birth. I have had plenty of moms tell me “just don't cut my vagina!” The truth is, if you ask your grandma or maybe even your mom, they probably had an episiotomy. It used to be routine standard care, every woman who delivered vaginally got an episiotomy. They used to think episiotomies healed better than natural tears and helped preserve the muscle and tissue in the perineum. 


An episiotomy is an incision made in the perineum, the tissue between the vagina and rectum, that is cut by your doctor to make the passageway for the baby a little wider. Now, it is not routine. Episiotomies are used only when necessary to help expedite delivery if the baby is in distress or to prevent worse tearing… YES an episiotomy can actually PREVENT very bad tearing.


I think most women think an episiotomy is where your vagina is cut all the way through to the rectum, that is not true. That is a very rare case, and that would be considered a fourth degree tear. Most episiotomies are only a small band of the tightest tissue close to the vagina opening.


Reasons why I would need an episiotomy?


  1. Baby is close to delivery, but in distress and needs to be delivered quickly.

  2. The baby’s shoulder is stuck behind the pelvis bone (shoulder dystocia).

  3. You’ve been pushing for a very long time (3+ hours) and are very close to delivering your baby, yet there is a tight band of tissue that's stalling delivery.

  4. Mom is very exhausted from pushing, close to delivery, yet has tight tissue holding back and agrees to episiotomy to speed up delivery.

  5. Used in assistance to needing a forcep or vacuum delivery for any reason.


Procedure:


If you have an epidural, you should really not feel the episiotomy. If you do not, your doctor will use local anesthesia like lidocaine to numb the area. It is very quick, they simply cut the smallest amount of the perineum possible to deliver the baby. The incision may be midline or cut at an angle called a mediolateral incision. Usually after an episiotomy is cut, delivery follows in a few pushes. After delivery the incision is repaired through dissolvable stitches along with any other tears.


How to avoid an episiotomy:


Some think perineal massage while pregnant can help the skin surround the vagina stretch easier during labor, there isn't much evidence behind this but you can try it. Mainly, push slow and push controlled. The rest is out of your hands. Whether your baby gets stressed and needs assistance or the band of tissue at your vagina opening is very tight around the baby's head is all out of your control. Have a birth plan, educate yourself, communicate with your nurse and provider, and just know in the end our goal is to deliver a healthy baby any route. Any episiotomy will never be cut without your consent. If your doctor thinks its necessary or will help speed up delivery in a situation where that is needed, they will talk to your first.


Healing:


Like I stated, stitches are dissolvable. The incision should heal right along with any other tear. It may be more sore and tender, especially sitting down. Make sure to get dermoplast spray from the hospital, it’s basically icy hot for the perineum. Also, use vaginal ice packs in your underwear to relieve some of the pain. You can take ibuprofen as needed for discomfort. Another major healing tip, take a stool softener (colace). Your doctor should put you on one postpartum regardless of having an episiotomy or not, but it does help soften any bowel movement to cause less trauma in that area. Use the squirt peri-bottle the hospital gives you as well instead of wiping with toilet paper.


Risks:


There are truly no risks different than a natural vaginal tear which most moms will have through a vaginal delivery. As with any tear there is a risk for infection (watch for any drainage from site/fever/chills), pain, bruising, swelling, pain during sex following recovery



links:


image from : https://goldengateobgyn.org/episiotomy-did-they-get-it-right-the-first-time/


https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282


https://americanpregnancy.org/labor-and-birth/episiotomy-751