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Episiotomy

Definition
An episiotomy is a surgical incision made in the area between the vagina
and anus (perineum). This is done during the last stages of labor and
delivery to expand the opening of the vagina to prevent tearing during the
delivery of the baby.
Purpose
This procedure is usually done during the delivery or birthing process
when the vaginal opening does not stretch enough to allow the baby to be
delivered without tearing the surrounding tissue.
1. To aid the delivery of the presenting part when the
perineum is tight and causing poor progress in the second
stage of labour.
2. To prevent third-degree perineal tears.
. To allow more space for operative or manipulative
deliveries! e.g. forceps or breech deliveries.
". To shorten the second stage of labour! e.g. with fetal
distress.

C. Types of episiotomy
There are three methods of performing an episiotomy#
1. $ediolateral or obli%ue.
2. $idline.
. & shaped
The midline episiotomy has the danger that it can extend into the rectum
to become a third-degree tear while the mediolateral episiotomy often
results in more bleeding. This s'ills wor'shop will only deal with the
mediolateral episiotomy because it is used most fre%uently! is safe! and
re%uires the least experience.
Precautions
(rior to the onset of labor! pregnant women may want to discuss the use
of episiotomy with their care providers. )t is possible that! with ade%uate
preparation and if the stages of labor and delivery are managed with
ade%uate coaching and support! the need for an episiotomy may be
reduced.
Description
An episiotomy is a surgical incision! usually made with sterile scissors! in
the perineum as the baby*s head is being delivered. This procedure may
be used if the tissue around the vaginal opening begins tearing or does not
seem to be stretching enough to allow the baby to be delivered.
)n most cases! the physician ma'es a midline incision along a straight line
from the lowest edge of the vaginal opening to toward the anus. )n other
cases! the episiotomy is performed by ma'ing a diagonal incision across
the midline between the vagina and anus. This method is used much less
often! may be more painful! and may re%uire more healing time than the
midline incision. After the baby is delivered through the extended vaginal
opening! the incision is closed with stitches. A local anesthetic agent may
be applied or in+ected to numb the area before it is sewn up (sutured).
,everal reasons are cited for performing episiotomies. ,ome experts
believe that an episiotomy speeds up the birthing process! ma'ing it
easier for the baby to be delivered. This can be important if there is any
sign of distress that may harm the mother or baby. -ecause tissues in this
area may tear during the delivery! another reason for performing an
episiotomy is that a clean incision is easier to repair than a +agged tear
and may heal faster. Although the use of episiotomy is sometimes
described as protecting the pelvic muscles and possibly preventing future
problems with urinary incontinence! it is not clear that the procedure
actually helps.
The use of episiotomy during the birthing process is fairly widespread in
the .nited ,tates. /stimates of episiotomy use in hospitals range from
01-213 of deliveries! depending on how many times the mother
An episiotomy is a surgical incision made in the perineum, the area of
tissue between the vaginal opening and the anus, during the birthing
process. This procedure may be used if the tissue around the vaginal
opening begins to tear or is not stretching enough to allow the baby to
be delivered vaginally. In the nited !tates, the rate of episiotomies
being performed is estimated at "#$%#&.
()llustration by /lectronic )llustrators 4roup.)
has given birth previously. This routine use of episiotomy is being
reexamined in many hospitals and health care settings. 5owever! an
episiotomy is always necessary during a forceps delivery because of the
si6e of the forceps.
Preparation
)t may be possible to avoid the need for an episiotomy. (regnant women
may want to tal' with their care providers about the use of episiotomy
during the delivery. 7egel exercises are often recommended during the
pregnancy to help strengthen the pelvic floor muscles. (renatal perineal
massage may help to stretch and relax the tissue around the vaginal
opening. 8uring the delivery process! warm compresses can be applied to
the area along with the use of perineal massage. 9oaching and support are
also important during the delivery process. A slowed! controlled pushing
during the second stage of labor (when the mother gets the urge to push)
may allow the tissues to stretch rather than tear. Also! an upright birthing
position (rather than one where the mother is lying down) may decrease
the need for an episiotomy.
Episiotomy Care
The open wound after incision is sutured post childbirth. The episiotomy
stitches get absorbed during the recovery period. 4enerally! the wound
heals completely on its own within a few months. 5owever! proper
postpartum care may promote faster healing. -esides! the ris' of
infections and other dangers can also be minimi6ed if you are well
informed about proper episiotomy care. 4iven below are some measures
to be ta'en during episiotomy recovery.
:nce you are in the recovery room! place an
ice pac' on your wound. This should reduce
swelling and numb the pain to some extent.
5owever! do not directly apply it on the
wound. )nstead wrap it in a thin towel and
then place it.
.sing witch ha6el pads or hemorrhoid pads
also help a great deal in soothing the
episiotomy pain.
7eep the area clean by changing underwear
and sanitary pads several times during the
day. ;ear cotton panties which allow
absorption and good aeration.
;hile you are urinating! s%uirt lu'ewarm
water with a peri-bottle. <ot only this will
dilute the urine and reduce the sting! but it
will also disinfect the area! thereby
preventing possible episiotomy infections.
,oa' the area in bath tub or better use sit6
bath. 5erbal sit6 baths are also available
which promote faster healing.
9lean the area every time you use a toilet.
=u'ewarm water wor's as good as any
other disinfectant.
;al'ing is a good exercise during the
recovery period as it encourages blood flow
to this area! thereby promoting faster
healing. 5owever! avoid overdoing it and
don*t wal' as soon as you are out of the
recovery room.
7egel exercises are very beneficial for
strengthening the wea'ened muscles in this
area.
=astly! maintain very good hygiene
throughout your recovery period. 9onsult
your :--4>< in case you experience
severe episiotomy pain and infection.
;ith good episiotomy care! you can resume your normal routine sooner
than you would expect. /ducate yourself more about episiotomy during
the final days of your pregnancy.
Postoperative Care
>our stitches will dissolve in about ten days. The cut will heal within
about two wee's. There may still be some soreness until the s'in gets its
natural strength bac'. This could ta'e up to six wee's. 8uring that time!
you may find it uncomfortable to sit or wal'. ;ays to care for your
perineum include#
?or the first 2" hours after delivery! apply ice pac's! wrapped in a
towel.
,hower to 'eep the area clean.
8o not strain when moving your bowels. >our doctor may as' you
to ta'e a laxative or stool softener.
.se a spray bottle of water to clean the area after going to the
bathroom.
Ta'e a sit6 bath (sitting in water) several times each day. .sually
warm baths are used! but cold! iced baths may offer faster pain
relief. ,tart with room-temperature water and add ice cubes. >ou
may stay in the water for 2@-@ minutes.
.se spray! medicated pads! or medicine as directed by your doctor.
?or example! you may use chilled witch ha6el pads that fit between
a sanitary nap'in and the area that was cut. >ou can also hold the
pads onto the area while you sit on the toilet.
;hen your doctor tells you to! do 7egel exercises . ,imply s%uee6e
the muscles you use to stop the flow of urine. This strengthens the
pelvic floor and can help the area heal faster.
Avoid having sex! douching! and using tampons for 0 wee's or as
directed by your doctor.
-e sure to follow your doctor*s instructions .
Aftercare
The area of the episiotomy may be uncomfortable or even painful for
several days. ,everal practices can relieve some of the pain. 9old pac's
can be applied to the perineal area to reduce swelling and discomfort. .se
of the ,it6 bath available at the hospital or birth center can ease the
discomfort! too. This unit circulates warm water over the area. A s%uirt
bottle with water can be used to clean the area after urination or
defecation rather than wiping with tissue. Also! the area should be patted
dry rather than wiped. 9leansing pads soa'ed in witch ha6el (such as
Tuc's) are very effective for cleaning the area and also feel soothing.
Care at 'ome
After delivering the baby! the perineum must be 'ept clean. =ochia may
drain for up to four wee's! so pads should be changed fre%uently.
8o not use tampons after delivery. Tampons may cause an
infection.
Ta'e a bath or a shower once or twice daily. A sit6 bath should be
used after every bowel movement. A sit6 bath involves sitting in
shallow water! only deep enough to cover the hips and buttoc's.
.rinating can be painful after delivery. ,%uirting warm water over
the perineum during urination may ease the pain. ;hen finished
urinating! gently pat the perineum dry.
9old sit6 baths help reduce swelling and discomfort after delivery.
,it in a lu'ewarm or room temperature bath! and then gradually add ice
cubes to the water. This prevents the uncomfortable! sudden sensation
of ice water on the s'in. ,oa' for 2@ minutes at a time! up to three to
four times a day. After the first two to three days! warm sit6 baths will
improve blood flow to the perineum. 9hec' with your physician before
adding medications such as epsom salts to the bath.
5emorrhoids are enlarged veins in the wall of the anus. They
fre%uently occur during pregnancy and often go away without
treatment after delivery. 5emorrhoids may bleed after bowel
movements. )f the hemorrhoids are painful! steroid suppositories may
lessen the discomfort.
,tay well hydrated by drin'ing plenty of water. ,training with
bowel movements will stretch the episiotomy scar and perineum and
can cause pain. Avoid constipation by eating fiber-rich foods such as
fresh fruits and vegetables. )f you do get constipated! you can gently
push up on your perineum as you bear down gently.
.sing an inflatable AdoughnutB cushion when sitting or lying
down may help reduce pull on the episiotomy scar.
7egel exercises strengthen and tone pelvic muscles and lessen
perineal pain. 7egel exercises are small movements of the vaginal
muscles similar to the movement you ma'e if you are trying to stop
urinating.
)f you are not allergic to acetaminophen (Tylenol) or ibuprofen
($otrin)! you can ta'e them to help control your pain. -oth drugs are
safe for a mother who is breastfeeding. )buprofen in particular is very
helpful for episiotomy pain and postpartum uterine pain.
Avoid sexual intercourse until you have no more perineal pain.
$ost health care providers recommend pelvic rest until four wee's
after delivery! but there are no clear guidelines. )f you need to use a
lubricant for sex! ma'e sure it is water-soluble.
(is)s
,everal side effects of episiotomy have been reported! including
infection! increased pain! prolonged healing time! and increased
discomfort once sexual intercourse is resumed. There is also the ris' that
the episiotomy incision will be deeper or longer than is necessary to
permit the birth of the infant. There is a ris' of increased bleeding.