What is an episiotomy?
We go through what an episiotomy is, why you might need one during childbirth, and how to recover.
What is an episiotomy?
Why might you need an episiotomy?
What happens during an episiotomy?
The type of episiotomy and the procedure itself may vary based on your condition, but generally an episiotomy follows the process below:
- You will be given an injection of local anaesthetic into the skin and muscle of the perineum. This causes the area to go numb so you won’t feel the incision being made. If you have had an epidural you won’t be able to feel anything from the waste down and may not need more anaesthesia for the episiotomy, though your doctor may top up this dose before the procedure.
- During the pushing stage of labour, as your baby’s head causes your vaginal opening to stretch, your doctor will use a scalpel or surgical scissors to make the episiotomy incision. There are two types of episiotomy incisions: midline or mediolateral. A midline incision is done vertically between the vagina and the anus; and a mediolateral incision is done at an angle.
- Once the episiotomy has been performed, your baby will be delivered through the enlarged vaginal opening.
- The placenta (afterbirth) will then be delivered.
- Your doctor will then examine the incision made to check for any further tearing that may have occurred during the birth.
- Dissolvable stitches (sutures) are then used to repair the incision to the perineal tissue and muscle.
Pros and cons of an episiotomy
- a further tear to the incision which may extend to the rectum and impact the anal sphincter muscle that controls the passing of stools,
- blood loss due to the incision and blood may collect in the perineal tissues,
- a risk of infection in the cut,
- some women may find sex painful for a few months after giving birth.
Recovering from an episiotomy
Episiotomy recovery can be uncomfortable or even painful. The degree of pain will depend on how long and deep the incision is. Pain may be particularly noticeable when you walk or sit, but can also impact urinating and bowel movements for at least a week. For some women, the first bowel movement following an episiotomy can be quite painful.
Pain from an episiotomy can last for a few weeks, though tenderness from an extensive incision or tear can last longer.
The stitches used to repair the episiotomy will dissolve on their own. While recovering, there are a number of ways to promote healing and help ease pain:
- Your doctor may suggest over-the-counter or prescription medication to aid in your recovery. These may include pain-killers, anti-inflammatoires, stool softeners, and anaesthetic sprays.
- You can soothe the wound by placing a cold ice pack wrapped in a towel on the area (never put an ice pack directly on your skin, and only apply for 20 minutes each hour). You can also chill a witch hazel pad and place this in your underwear between a sanitary pad and the wound.
- To prevent stretching or pain during bowel movements, press a clean sanitary pad against the perineum to provide support to your wound as you are passing a bowel movement. Drinking lots of fluids will also help soften stools.
- To avoid infection, only wipe your perineal area from the front to back, starting at your vagina and working back towards the anus
- To help with stinging during urination, pour warm water on your vulva as you urinate. Rinse yourself using a squeeze bottle afterwards.
- It may be painful to sit in the weeks following an episiotomy. To help with this, sit on a pillow or a padded ring (you can buy these from your local pharmacy). You can also tighten your buttocks as you lower yourself into a seat.
- Lavender may help with pain after an episiotomy. If your doctor says this is ok you can add a few drops of lavender oil to your bath.
- Taking regular warm baths using Epsom salts and other additions suggested by your doctor may help relieve pain and reduce swelling to the perineal area.