What is an episiotomy and will I have to have one?

If you’re planning a vaginal birth (or have ever sat in on a mother’s group conversation) then chances are you’ve heard the term, episiotomy come up. It’s often accompanied by shivers and sympathetic grimaces.

What is an episiotomy?

An episiotomy is a surgical procedure in which an incision is made in the perineum, the area between the vaginal opening and the anus, during childbirth. The purpose of an episiotomy is to create a wider opening for the baby to pass through, potentially reducing the risk of extensive tearing and facilitating a smoother delivery.

Historically, episiotomies were performed routinely as a standard practice during childbirth. However, their use has significantly decreased in recent years due to growing evidence suggesting that routine episiotomies may not provide substantial benefits and may increase the risk of complications.

When an episiotomy is deemed necessary, it is typically performed under local anesthesia and may be either a midline episiotomy (perpendicular to the vaginal opening) or a mediolateral episiotomy (angled to the side). The specific type of episiotomy performed depends on the healthcare provider’s judgment and the circumstances of the delivery.

After the baby is delivered, the episiotomy incision is typically sutured (stitched) to promote healing. Proper care and hygiene of the episiotomy site are essential to minimise the risk of infection and promote healing. The sutures used are typically absorbable and dissolve on their own over time.

It’s important to note that episiotomies are not performed routinely during childbirth anymore. They are typically reserved for specific situations where there is a perceived need, such as cases of fetal distress, instrumental delivery (e.g., forceps or vacuum extraction), or when a spontaneous tear is likely to be more severe than an episiotomy.

The decision to perform an episiotomy should involve a discussion between the healthcare provider and the expectant mother, weighing the potential benefits against the risks and considering individual circumstances.

How is an episiotomy performed?

Your doctor or midwife will perform the procedure and will either top up your epidural if you have one or provide some local anaesthetic to help numb the pain so you cannot feel it.

There are generally two types of incisions:

• Midline incision is a vertical incision, and is often easier to repair, however there is risk of it extending to the anus.
  
• Mediolateral incision is done at an angle and means you have less risk of the tear extending to anus, but can be more difficult to repair and also more painful.

Following the birth of your baby, your doctor or midwife will then stitch up the incision with dissolvable stitches.

What is the recovery like?

As the doctor/midwife uses invisible stitches there should be no follow-ups required, however, recovery can take anywhere up to 6 weeks and can be quite painful.

As with any surgery, there will likely be some bleeding afterwards. This should ease off within the first few days and the stitches should heal and disappear within approximately a month.

It is normal to feel pain down there for a few weeks, especially when you go to the toilet, speak with your doctor/midwife about the best ways to manage it.

One piece of advice is to purchase a peri bottle which enables you to gently cleanse yourself after going to the bathroom in the weeks after childbirth because, trust us, you will not want to be wiping with toilet paper!

If the pain is getting worse, bleeding doesn’t stop or you develop a fever or rash, contact your doctor immediately.

Are there any risks or side effects?

As mentioned above, there is a risk that the incision will extend down to the anus, also known as fourth-degree vaginal tearing and can lead to fecal incontinence – but this is uncommon.

There is also the risk of infection during the recovery, and pain during sex in the months following the birth.

Speak to your doctor or midwife in the lead up to the birth about their thoughts on episiotomies and ask them any questions as well as raise any concerns you may have. While they will do what they feel is best in the situation – as they are there to look after you and your baby and if there are complications they will do what they have to do – but it doesn’t hurt to have the conversation in advance.

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