Problems in labour: Episiotomy

Reasons for an episiotomy to overcome problems during labour and birth plus suggestions for aftercare.

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An episiotomy is a cut made in the perennial tissues to make the outlet bigger for your baby. It is something that you need to give consent for and your midwife should discuss with you.

Reasons for episiotomy

• To speed your baby's delivery it is distressed.



• To enable your baby to be delivered more easily with minimum trauma to you when forceps are used. (Sometimes it is also considered necessary to perform an episiotomy when you have a ventuse delivery.)



• To prevent overstretching of the perineum and reduce the risk of a severe tear.

Significant evidence exists to suggest that an episiotomy should be avoided whenever possible. Sometimes changes your delivery position so that you are leaning forward reduces the amount of pressure on the perennial are reducing trauma. You can in this case sustain some tears at the front, but generally they are much less deep. If your baby is in distress or you need to have an instrumental delivery then there may be no alternative. In this case if you do not have an epidural you will be given local anesthetic before the procedure is done. A cut is made from the middle of your perineum downwards and towards the right. This is to try to avoid any damage to your anus or back passage.

Aftercare

Often your baby is born very quickly after the episiotomy has been performed. Soon after the birth your doctor or midwife will repair your perineum using dissolvable stitches. The process can sometimes take quite a long time and you may need more local anesthetic before it is done.

If you have any tears after delivery you may also need some stitches. In both cases it is important to keep the area clean, change your pads frequently and make sure you wash and dry the area carefully, at least once a day using just water. Be particularly careful with hygiene if you have your bowels open.

You may well need some pain relief to keep you comfortable so that you can enjoy time with your baby. Ask you midwife or doctor about this. In the first few days cold compresses often help, the hospital may be able to supply something, or you can buy specially designed gel pads that you freeze. Alternatively if you are at home frozen peas might help. Whatever you use, cover it first with something clean and soft so that the ice is not right next to the skin

It is very common to have some bruising and swelling in the perennial area whether or not you need stitches. Your midwife will be able to keep a check on things so please ask if you are concerned. A day or two after the birth it is a good idea to restart your pelvic floor exercises as this will help the healing process.