What is an episiotomy?
What is an episiotomy?This is a small cut made by your doctor or midwife in the perineum (the area between your vagina and your anus). It makes the birth canal wider, helping the baby to come out more easily.
Following the birth, the cut is stitched or sutured and it should take about four weeks to heal. Because the stitches are dissolving, you won’t need to have them removed.
Episiotomies are not performed routinely but may be done if the baby needs to be born quickly. This is the area where you might tear naturally during the birth, so making a small cut may prevent excessive tearing that might be difficult to sew up again. Your doctor or midwife will discuss this with you if they feel that it is necessary.
Following the birth, you may have some pain at the cut for a few weeks and passing urine and sex may be uncomfortable for a while too. See Sex After Childbirth.
Why might I need an episiotomy?
There are four main reasons why you might be given and episiotomy
If your baby gets into difficulties and his heart rate increases or decreases. This is known as foetal distress and may your baby may not be getting enough oxygen.
When it’s a bit late to perform a Caesarean, for example when the baby’s head is quite far down the birth canal and your health team wants to speed up the birth.
If you need any kind of intervention involving instruments, like forceps or a ventouse suction device.
Your baby is in the breech position (feet first)
A episiotomy can speed up the birth if you are very tired and your health team want to speed up the birth, or if you have a medical condition and need to deliver quickly.
How is an episiotomy done?
First, you will be given a small anaesthetic injection into the area around the vagina. This won’t be needed if you have an epidural in place. Them a small, diagonal cut is made at the back of the vagina – down and to one side.
How long does it take to recover from an episiotomy
Though the cut may bleed freely at first, your doctor will use pressure and stitches to repair the cut, usually within an hour of the birth. Because the stitches are dissolvable, you don’t need to go to hospital to have them taken out. The cut should heal within about four weeks. Ask your doctor or midwife to check the healing is going well at your six week check-up.
Pain
If the cut is painful, you can take paracetamol if you are breastfeeding. You can also take Ibuprofen, though not if your baby was premature, had a low birth weight or has a medical problem. Don’t use aspirin as it is passed onto your baby through the breast milk. You can also try using a ring-shaped pillow or even a blow-up swim ring to take pressure off the area when you’re sitting down. Ice packs wrapped in a towel or flannel can also help. It can also help you get the air to the cut, so go panty-free for a time each day if you can – perhaps whilst relaxing on your bed.
I’m scared to go to the toilet
It’s natural to be a bit scared of using the loo after an episiotomy. When passing urine, have a jug of warm water next to the loo and pour it over the vaginal area as you pee. This also helps avoid infection.
When you need to poo, you might find it helps to press on the cut gently with a clean pad to avoid straining the stitches – a clean cotton wool make-up pad is ideal, or a small sanitary towel.
Always wipe from front to back to avoid infecting the wound and again, warm water can be used to help you clean the area. Avoid soaps or washes that might be drying. If you are tense about going, you might develop constipation; try to avoid this by not ‘hanging on’ and by eating plenty of fresh fruit and vegetables and drinking plenty of water. You might also need a gentle laxative.
Pain during sex
Take your time after the birth before resuming sex and try it again as soon as you feel like it. Remember that it may hurt if you have had stitches and you must help your partner to know what’s OK and what’s not. Talk it through with him so that he knows your fears and can help you relax.
You can use a water-based lubricant if sex is difficult at first and this may be due as much to changing hormones as to the discomfort of an episiotomy scar.
Don’t forget that even if you are breastfeeding, you can still get pregnant! Make sure you have contraception.
Help – I think the scar is infected
If the area around your vagina becomes painful, hot, red or swollen or you notice a discharge or pus, go back to your doctor as the scar may be infected. They can start you on a course of antibiotics.
How can I help it heal?
Doing your pelvic floor exercise or Kegels will help to get the blood flowing around the area and thus promote healing. There are a couple of ways to get started doing this if you haven’t done so before – when you go for a pee, try to tighten the muscles to stop the flow. Hold it for a few second and then release. You can repeat this several times if you’re able! You can also do this when you are sitting down – during breastfeeding is an ideal time. Think about the figure of eight muscles that surround your urethra and back passage. Tighten them, then release and repeat as many times as you are able. This also helps strengthen pelvic floor muscles that might have become weaker due to childbirth.
The scar is raised, itchy or red
If you find, as a few women do, that the scar from an episiotomy or where you tore is healing badly for example, it is raised, lumpy, red or itchy, you may need another small operation to improve the feeling of the area. When the scar has healed, usually about six months later, a surgeon can remove badly formed scar tissue and re-suture the edges neatly.
Can I prevent an episiotomy?
Your best bet to avoid tearing is to really listen to your Midwife. If she feels you are pushing too quickly and at risk of tearing, she will ask you to try to stop pushing and to take lots of rapid, short breaths. This usually helps the perineum adjust as the baby’s head emerges.
You may also want to massage the area before birth to make the skin more pliable and stretchy. You can find perineal massage oil and gently massage it into the perineum for a few weeks before the birth.
To get the best effect, research suggests that doing this twice a week is most beneficial and the technique is to push one or two fingers into the vagina and sweep downwards towards the perineum.