Until a few years ago, an episiotomy was performed as a routine procedure but this has changed based on new research. Doctors have begun to exercise discretion depending on various factors relating to the delivery. An episiotomy, a surgical cut that is made on the perineum (the area between the vagina and the anus), is done during a vaginal delivery to enlarge the outlet.
Some of the reasons for performing an episiotomy are:
- Likelihood of extensive vaginal tearing during delivery
- Abnormal position of the baby
- Size of the baby is larger than usual
- There is a need for faster delivery
There could be other complications because of which your doctor might ask you to opt for an episiotomy. If your doctor recommends one, ask them about the procedure and how it can help your delivery. Knowing more about the procedure can help you understand the benefits and possible aftereffects of episiotomy. There are 2 different types of episiotomy you should know about before you commit to the procedure:
1. Mediolateral Episiotomy
In a mediolateral episiotomy, the perineal tissue is cut downward from the fourchette (rear rim of the vulva) and outward towards the ischial tuberosity (the rounded protuberance on the hip bone on which the body rests while in a sitting position). The diagonal incision is made either to the right or left in a straight line that runs for about an inch.
- The chances of perineal damage are low
- Third degree and fourth degree perineal tears are unlikely
- Can lead to increased bleeding
- Healing is more difficult and painful
- Greater chance of scarring
2. Median Or Midline Episiotomy
Here, the episiotomy incision is made in the midline, extending from the centre of the fourchette towards the anus for 1 inch.
- There is lower blood loss
- It is relatively less painful
- Healing is easier
- Chances of scarrring are lower
- Increased risk for tears that extend into or through the anal muscles.
- May result in anal incontinence (inability to hold feces in the rectum)
Recovering From An Episiotomy
An episiotomy incision may bleed heavily at first but usually stops once the doctor closes the wound with sutures. The episiotomy wound normally takes 4 to 6 weeks to heal. The time to heal depends on the length of the incision and the suture material used.
Maintain Hygiene To Avoid Infection
Because the region is colonized by bacteria and frequently contaminated by fecal matter during the process of delivery, there exists a significant risk of infection. So you must take care to keep the region clean and follow hygiene instructions provided by your doctor.
Take Measures To Relieve Pain
Sutures used to close the wound will dissolve and a hospital visit is usually not required to remove them. However, you will experience pain and discomfort for 2 to 3 weeks or longer after the episiotomy. Here are few ways you can relieve the pain:
- Apply cold packs on the perineum
- Avoid foods that could cause constipation
- Take pain relievers after talking to your doctor
- Use a squirt bottle instead of toilet paper to clean yourself after using the toilet
- Apply lubricant when having sexual intercourse (consult your doctor about resuming sexual activity after your delivery)
The amount of time required to heal depends on the severity of the tear. Most episiotomy incisions heal within a month with minimum scarring though scarring is more likely after a mediolateral incision than after a midline one. You might feel discomfort when walking and burning during urination, but with time and proper hygiene, the incision will heal allowing you to go back to normalcy.