Episiotomy - To Cut or Not to Cut

Most women worry about being cut during labor. This concern is real. After all it does sound daunting to have a cut down there but in some cases it cannot be helped. The cut in the muscular area between the vagina and back passage (perineum) was a routine procedure in the past but now it is only performed if your doctor thinks it necessary.

When a Cut becomes necessary..

• Perineum hasn't had the time to stretch and the birth is imminent
• When baby is in distress
• If baby's head is too large for the vaginal opening
• If forceps is required; sometimes it is necessary to have an episiotomy in forceps delivery
• In breech position complications are very likely so a cut may become necessary
• If your doctor feels your perineum is going to tear in several places
• If your doctor feels your perineum is not thinning and stretching and this is holding your baby back

The Facts..

• Complications can be serious so an episiotomy should only be performed if medically it is deemed necessary. Muscles, skin and vessels at the back passage can be badly damaged especially in instances when the cut is made too early
• This can result in bruising, swelling and a tightly stitched perineum which may be quite uncomfortable for some months, and possibly scarring
• In comparison when you are left to tear naturally, the tear is adequate enough to let the baby out
• Spontaneous tears are less painful than cuts
• Without an episiotomy your pelvic floor muscles are likely to be stronger after giving birth
• If you have to have an episiotomy, a local anesthetic will be administered before the cut is made
• Sometimes an episiotomy is not planned before hand so the cut will be made without an anesthetic. Since it will be made at the peak of contractions when the vaginal tissues are stretched and tight the cut will be made quite easily and will be literally painless.
• Another shot of anesthetic will be given before you are stitched up

After care..

You will need to take special care after an episiotomy since you have been stitched up. The stitches need to heal well and things will be worse before it gets any better. Most stitches take about a week to dissolve

• Have regular baths with water that is very diluted with tea tree and lavender oils to help speed up the healing
• Place an ice-pack on the stitches to numb the area and reduce the swelling
• Practice hygiene and keep the perineal area dry and clean; wash stitches gently and regularly with warm water. Air dry or fan yourself dry with a newspaper. Avoid using toilet paper or even towel as it may be too rough on the sensitive area right now
• Take vitamin C to speed up healing
• Try leaning forward when you pee to avoid the pee from coming into contact with the wound. You can also stand and pee or pour warm water over as you pee
• Avoid constipation by taking lots of water and fiber and stay mobile no matter how tempting it feels to stay in bed
• If you fear emptying your bowels the first time, it will help if you held a folded sanitary towel against your stitches
• Get hold of a Valley cushion; alternatively sit on a rolled up towel or place a pillow under each buttock
• Check with your doctor on safe painkillers
• Pelvic floor exercises help increase blood flow to the area and this assists in the healing process
• Sex is advisable preferably after the 6th week checkup

Some ways to avoid an Episiotomy

• Do your pernineal massage if you are comfortable with it
• Try staying in an upright position during labor
• Push gently when your baby's head crowns. Allow your uterus to ease out the head gradually rather than suddenly. You are likely to tear if this happens and to mend the jagged edges an episiotomy will be performed