Everything You Need To Know About An Episiotomy: Types, Care, And Healing

Until a few years ago, healthcare providers routinely performed episiotomies during vaginal birth, assuming that this procedure protected women from spontaneous perineal tears, which are more difficult to heal and could lead to future complications like urinary incontinence. 

Doctors also believed newborns face birth trauma due to their heads pushing against the perineum during labour for too long. However, recent research conducted by the American College of Obstetricians and Gynaecologists (ACOG) confirms that both mums and newborns do well without a standard episiotomy, and no longer recommends this procedure to be performed routinely.

But this doesn’t mean all women can avoid this procedure during childbirth. Since every pregnancy is different, complications vary, and so does the probability of an episiotomy. To help you understand better, we have gathered all the details about this procedure and when is it considered necessary during labour. 

What Is Episiotomy?

An episiotomy is a surgical procedure that involves making an incision in your perineum (the area between your vagina and anus). This incision is made right before a vaginal delivery to enlarge the vaginal opening and help your baby’s head and body emerge. 

When Is an Episiotomy Procedure Considered Necessary?

While episiotomies are not recommended as often as they were before, there are a few circumstances where this procedure may be considered crucial. These include

• Your baby’s head is big: In this case, your little one will need a little more space to exit, and hence, the doctor might consider performing an incision to make your vaginal opening larger.
• Your delivery requires the use of forceps or vacuum: These tools need space to maneuver and hence an episiotomy may be considered crucial.
• Pregnancy complications: If your baby is in a breech position (bottom or feet first) or has shoulder dystocia (meaning their shoulder is stuck in the birth canal), then an episiotomy is performed.
• Preterm baby: An episiotomy may be recommended if your baby is preterm.
• Fetal distress: If your doctor determines that your baby’s heart rate is low or they are in distress, then they might perform an episiotomy for your child to be born right away.

What Happens During An Episiotomy Procedure?

If you require an episiotomy, then you will be first injected with a local anesthetic to numb your perineal area. Next, during the second stage or more commonly referred to as the pushing stage of labour, your doctor will use scissors or a scalpel to make an incision and enlarge your vaginal opening.

After delivering your baby and the placenta, your doctor will stitch up the incision and prescribe some medications to relieve the pain.

Episiotomy Types

The two common types of episiotomy are midline and mediolateral episiotomies. A midline episiotomy is more common in the United States and Canada, while the mediolateral method is preferred in other parts of the world. Both methods have various advantages and disadvantages. 

Midline Episiotomy

In this procedure, the incision is made in the middle of your vaginal opening, straight down toward the anus. The advantages of this procedure include easy repair and improved healing. It is also less painful and involves less blood loss. 

However, the main disadvantage of this procedure is the increased risk of tears that extend into or through your anal muscles. This may lead to long-term complications, including fecal incontinence, or the inability to control bowel movements.

Mediolateral Episiotomy

In a mediolateral episiotomy, the incision begins in the middle of your vaginal opening and extends down toward your buttocks at a 45-degree angle. The primary advantage of this procedure is the low risk of anal muscle tears. However, there are many disadvantages associated with this procedure, including

• Severe pain
• Increased blood loss
• Difficulty in healing
• Higher risk of long-term discomfort, especially during sexual intercourse.

Recovering from an Episiotomy

Like any wound, the site of episiotomy will take time to heal, usually 7-10 days. To prevent infection or inflammation, your doctor may recommend some postpartum perineal hygiene tips like

• Using ice packs: Ice wrapped in a washcloth or cold compresses can help ease swelling and reduce pain.
• Pain relief medications: Your doctor may prescribe over-the-counter medications like ibuprofen or a numbing spray or cream.
• Keeping the incision site clean: Use a small plastic bottle to spritz the perineum during and after urinating, and gently pat the area dry with a baby wipe or a soft towel.

Is There a Way to Avoid an Episiotomy?

In some cases, an episiotomy is considered crucial, based on your overall health and condition. But there are ways to reduce the risk of administering this procedure. Here’s what you can try.

• Practice Kegels: Kegels help improve your muscle tone and stimulate circulation near the perineum area.
• Massage your perineum: Massaging your perineum help stretch the area and facilitates smoother delivery.
• Use warmth: A warm compress applied to your perineum during labour helps soften your skin, enabling it to stretch better.
• Push slowly: Push for only 5-7 seconds at a time and bear down gently.

Conclusion

While an episiotomy is considered necessary in a few cases, the good news is that this process isn’t recommended routinely anymore. Moreover, you can also try the tips that we have mentioned above to reduce the risk of getting an episiotomy during childbirth. Discuss the process with your doctor beforehand to determine whether you need an episiotomy and if you do, how can you prepare your body for the procedure and what steps to take for better healing. 

Also read:

What to expect when your water breaks: When does your water break during pregnancy and what should be your next plan of action? Find out all the details in this post. 

What to expect during vaginal birth: Here’s everything you need to know about vaginal birth and different labour stages. 

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