Episiotomy — Must I be ‘cut’ and stitched during my baby’s birth?
Episiotomy is the technical term for the perineal cut administered to quicken the exit of your baby during delivery. It is simply an incision undertaken by a midwife on the perineum of a mother during delivery to create room for the baby to pass through. The perineum is the area between your vagina and the anus.
Episiotomies are not performed on all women during delivery. Some will need it, yet others will not. It depends on how much room there is for the baby to pass through.
A cut or a tear
When giving birth, it is not uncommon for perineal tissue to give way to tension caused by the baby’s exit. In such circumstances, a ‘tear’ of the perineum will occur naturally. If small, a tear may be preferable to a cut mainly because it follows body tissue joints. Muscle tissue is not affected, unlike in a cut, which may go through some muscles. However, some tears may be extensive and are more difficult to heal due to their ragged nature.
Tears, especially small ones, will heal naturally and in most instances will not require any stitching. You can choose in your birth plan whether you want the midwife to automatically administer a stitch if you tear. Alternatively you may opt, if a tear is small, to heal naturally without stitching.
On the other hand, a ‘cut’ is artificial and is surgically made by the midwife. An episiotomy is a surgical cut which is deliberate and easier to heal.
It can be avoided where a normal birth is occurring with ease and the baby is not at risk. Episiotomy is definitely advisable and necessary if difficulty is being experienced. Ordinarily, your midwife should explain the potential need for episiotomy and get your consent ahead of the delivery.
Who needs an episiotomy?
Women whose perineal muscles are too tight need an episiotomy. These include women delivering for the first time and women who have gone through female genital mutilation (female circumcision).
Women delivering for the first time may fail to stretch their perineum to accommodate the baby’s head as it passes through the birth canal. Women, who underwent female genital mutilation earlier in their lives according to customary requirements, may have developed scars in the perineum muscles. Because they are scar tissues, these muscles fail to stretch during delivery.
Besides these, most other women’s perineal muscles can stretch wide enough to allow the baby to be delivered and do not need one.
Women who suffer from diabetes during pregnancy are likely to have big babies because the increased sugar in their blood crosses to the baby through the placenta. The baby may be so large that it cannot pass through the vulva unless more room is created using an episiotomy.
If for whatever reason the birth canal is small, an enlargement of the opening has to be made. The incision should be made only by a qualified professional.If the incision is necessary but not made, then the mother risks tearing badly during birth, or risks the baby getting stuck altogether
How an episiotomy is done
If an episiotomy is reasonably expected, your midwife may apply an anesthetic before making the incision. A local anaesthetic is injected into the area where the incision is to be made. Once the baby’s head appears, your midwife waits for your contraction to be intense, since that is when the perineum becomes very thin and ready for quick and precise cut.
Must I be ‘CUT’ and stitched during the birth off my baby?
In some cases, an episiotomy may become necessary midstream and there may be no time to discuss it, so it is important that you understand this possibility before you enter the delivery room and give your consent for the operation.
The incision is made diagonally away from the midline to prevent tears into the anus. After the delivery process the incision is sewn together immediately with absorbable stitch that does not need removal.
Should you worry about episiotomy?
An episiotomy is a minor surgical procedure and the cut heals easily, so it should not alarm you. However, it is important that you observe proper hygiene after the cut, especially in bathrooms and toilets, as cuts and tears can become infection entry points.
Will an episiotomy keep you in hospital?
No. Once an episiotomy has been done, there is no reason to retain you in hospital unless there are other factors necessitating your continued admission. You can take care of the wound while at home, but you must maintain proper hygiene to avoid infection.
How to take care of an episiotomy wound
Shower as often as you feel necessary but avoid using vaginal douches for a while until the site is completely healed. Treat the incision site using warm, salty water. It is better to use a clean piece of cloth to sponge the area at least twice every day rather than sitting in a basin of salty water because if the basin is not as clean as required, the area may get infected. However, if you chose to use a basin, it must be disinfected before use and must not be used for any other purpose while still under use for cleaning the wound.
Abstain from sex until the wound heals and you feel comfortable enough to make love again. It takes three weeks on average to heal.
Use sanitary towels instead of tampons until the site is completely healed.
Reducing the chances of having an episiotomy?
You can reduce the probability of having an episiotomy by regularly doing pelvic floor exercises. Being active, for example walking rather than always driving, will train your muscles in readiness for childbirth.
As long as you are attended to by qualified medical personnel, an episiotomy should not worry you as it is easily done and stitched with minimum risk involved.
END: PG 1/38-39