Episiotomies

We explain what an episiotomy involves, when its neccessary, how you can minimise your chances of needing one using perineal massage and the recovery process.

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Labour > Episiotomies

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What is an episiotomy?

Episiotomies are performed during the final stage of labour, often just as baby's head is crowning, and involve a surgical incision being made in the perineal tissue between the vaginal opening and the anus. In the past episiotomies have been performed as a standard procedure as it was believed that a surgical cut was preferable to a perineal tear in terms of both imminent healing and prolonged damage. This is no longer thought to be the case and as a result far fewer episiotomies are performed.

How are episiotomies performed?

If an episiotomy is deemed necessary the perineal area will be numbed using a local anesthetic (or an epidural top-up) and a surgical cut will be made in the perineal tissue. There are two types of cuts; a midline cut which is a straight line from the back of the vagina to just before the opening of the back passage and a mediolateral cut which begins as a straight line cut at the bottom of the vagina but is directed diagonally to avoid the back passage (this is most commonly used in the UK). Once the baby and placenta have been delivered the cut will be sealed using soluble stitches that dissolve as the wound heals.

When are they necessary?

Although episiotomies are no longer performed routinely there are some instances when they are deemed necessary, these include...

• If the baby is in distress and needs to be delivered quickly



• If the baby is particularly large and there is difficulty delivering the head



• If the baby is in a breech or other awkward position



• If there has been previous damage to this area or if the perineum begins to tear in multiple places

What can I do to avoid an episiotomy?

Unless you have any of the above problems it is unlikely that you'll need an episiotomy, however there are some steps you can take to reduce your likelihood of needing one. These include.....

• Eating well and keeping hydrated so that your skin has maximum elasticity



• Practicing pelvic floor exercises throughout your pregnancy to help maximise your pushing ability and your pelvic control



• Opting for an active labour and adopting different birth positions depending on the stage - i.e. squatting when you need to push or going on all fours with your hips in the air when you need to wait



• Daily perineal massage leading up to the birth is also said to increase the elasticity of the perineal tissue and therefore its ability to accommodate your baby's passage. To do this you should clean your hands, trim your nails and use a vitamin E oil or water based lubricant on your fingers and perineum. You should place your thumbs inside the vagina and gently push down and to the side until you can feel a tingly or stinging sensation. You should then massage the lower part of the vagina with finger and thumb



• Using perineal massage and a warm compress to help relax these muscles during labour may also help you to avoid needing an episiotomy

If you feel very strongly about avoiding an episiotomy during childbirth its best to both write this in your birth plan and mention it to the team caring for you during labour.

Healing and recovery

Regardless of whether you have an episiotomy or not you are likely to feel uncomfortable 'down below' for a while after giving birth. It can take up to a month for you to heal and for the stitches to disolve. To help alleviate the discomfort you could try placing an ice pack on the stitches to help numb the area and reduce swelling, having warm baths or using a sitz bath (which you fill with warm water and place on the toilet) or swabbing the area with witch hazel or arnica. It is very important to keep the perineal area clean while it heals so its best to wipe from front to back when you go to the toilet or alternatively to use a squirty bottle to wash yourself instead. Exposing the stitches to air whenever possible and recommencing your pelvic floor exercises will help to stimulate circulation and speed up the healing process.