Episiotomy

If you are planning on having a vaginal delivery, it is important to discuss with your health care provider whether or not you are willing to have an episiotomy. Once a routine procedure during labor and delivery, episiotomies have become a controversial part of the birthing process.

What is an Episiotomy?
During labor, it is very common for women to experience vaginal tearing as the baby passes out of the vaginal opening. In order to prevent these vaginal tears from occurring, doctors will often perform an episiotomy. In this procedure, an incision is made in the perineum, which is the area between the vagina and the anus. This incision allows the vaginal opening to enlarge, thereby giving the baby more space to emerge from.

The procedure for an episiotomy is fairly simple: local anesthetic is applied to the perineum and an incision is made just before delivery. Following the birth of your baby and the delivery of the placenta, the incision is sutured shut with dissolvable stitches.

Courting Controversy
In the past, episiotomies were just a standard part of the labor and baby delivery experience. However, the procedure has come under fire in recent years due to the emergence of evidence that an episiotomy may not actually be that beneficial to a woman. Studies have shown that, even if a woman does not have an episiotomy, she is not anymore likely to experience vaginal tearing. If she does tear, it is likely to be small and in most cases no worse than an episiotomy.

Since episiotomy is no longer a standard part of vaginal births, the rates for this procedure have declined. In the United States, episiotomies were performed in 39% of all vaginal deliveries during 1997, down from 65% less than 20 years before. However, many feel that the number of women still having an episiotomy remains far too high. Experts argue that the number of episiotomies performed in vaginal births should not exceed 20%, while others feel that episiotomies should only be done in no more than 10% of vaginal births.

So why the push for fewer episiotomies? Aside from the fact that the procedure is often not actually necessary, there are also many risks associated with it. In the past, an episiotomy was believed to heal faster than a vaginal tear and with fewer complications. It was also thought to aid in tightening the vagina after birth and prevent vaginal stretching. Current research on the topic, though, is showing that this may not be true.

Women who have an episiotomy often lose more blood during delivery. They also report longer, more painful healing times after birth and tend to experience more complications. Additionally, women who have an episiotomy are more likely to have weaker pelvic floor muscles after birth. Due to these factors, as well as the numerous risks associated with the procedure, some groups that oppose episiotomies have even referred to the procedure as genital mutilation.

Risks
Some of the risks associated with episiotomy include:

Infection
Loss of sexual sensation; increased discomfort during sex
Incontinence

Having an episiotomy also increases your chances of experiencing a severe tear during birth. In fact, it is one of the main risk factors for this labor complication. Severe tears that go close to or near the rectum tend to take an especially long time to heal. More significantly, these vaginal tears can lead to fecal incontinence.

The Necessity of the Procedure
Despite all the problems associated with episiotomies, there are times when the procedure is warranted. In fact, it can be a life saving procedure for both mother and baby when it is medically necessary. The main reason why an episiotomy should be performed is if your baby is in distress, particularly respiratory distress, and needs to be delivered quickly.

In general, midwives tend to perform fewer episiotomies than obstetricians. However, it is still important that you discuss with your health care provider just how often she does episiotomies and under what circumstances. You should also outline in your birth plan whether you are willing to have an episiotomy. Also, you can do a perineal massage in the weeks leading up to your birth, which may help prevent an episiotomy.

Your Episiotomy Postpartum
Here are some things you can do to help with episiotomy healing.

Immediately after birth, use ice packs to minimize any pain and swelling

To ease discomfort, have a warm bath or a sitz bath several times a day

After a shower or bath, make sure the wound is completely dry before you get dressed

Try not to sit too much

Expose the area to air whenever you can

Avoid constipation by drinking lots of water and eating a diet high in fiber

Continue doing your kegel exercises to help strengthen your pelvic floor muscles

Avoid having sex for four to six weeks and/or until your health care provider gives you the green light