What is an Episiotomy?
An episiotomy is a procedure performed to prevent vaginal tears from occurring. When an episiotomy is performed, local anesthetic is applied and then an incision is made in the perineum (area of skin between the vagina and the anus). The incision is done to enlarge the vaginal opening so that the baby can be delivered more easily. As soon as you have given birth and the placenta is delivered, another injection of local anaesthesia is given and the incision is stitched closed. Stitches do not have to be removed, as they are absorbed by the body.
In recent years, quite a bit of controversy has surrounded episiotomies being performed. Previously, it was thought that an episiotomy healed much faster than a vaginal tear without any problems, prevented vaginal stretching and helped to tighten the vagina after giving birth. Research has shown that even if a woman does not have an episiotomy, she may still experience vaginal tearing as the baby is released from the vaginal opening.
The healing period for an episiotomy is usually very long, approximately 4 to 6 weeks, and depends on the size of the laceration. Because these stitches are in a very tender area, it is very important that you take certain precautionary measures to heal completely.
What are the risks of an episiotomy?
An episiotomy increases your risk of:
- Lack of strength of pelvic floor muscles
- Increased pain
- Swelling and bruising
- Severe vaginal tears and lacerations
- Loss of sexual sensation and discomfort during sex
- Longer healing and recovery period
When is an Episiotomy Necessary?
Despite the controversy surrounding an episiotomy, in certain instances this procedure may be necessary to be performed for the health and well being of both mother and baby.
An episiotomy may be performed:
- If the baby is in distress (changes in the heart rate, respiratory distress, prolonged second stage of labor or the mother is exhausted) and needs to be delivered quickly
- If the baby is too large for the mother’s vaginal opening
- If the baby is in breech position (feet or buttocks coming first)
- If a forceps-assisted vaginal delivery or vacuum extraction is performed
- If twins are being delivered your obstetrician may need more room to get them out
- If you cannot control pushing
How to Help Prevent an Episiotomy
It is very important to outline your birth preferences in a birth plan to have an episiotomy performed or not. Discuss carefully with your obstetrician or midwife how often they perform episiotomies, under what circumstances this procedure is done, and whether tearing can be avoided.
To help prevent an episiotomy from occurring, perineal massage may be done at least five to six weeks before the delivery. Eating healthily throughout your pregnancy helps to stretch the skin, practicing Kegel exercises and applying warm compresses during delivery may also prevent the need for an episiotomy.
Help for Episiotomy Healing
Natural and holistic remedies can prepare the perineal area for childbirth and assist in healing of episiotomies, perineal soreness and tearing after birth. Carefully selected ingredients containing herbs, minerals and vitamins such as Vitamin E Oil, Silica, Comfrey oil and Lavender oil promote healing, acts as an antiseptic and reduce swelling and pain.
Other ingredients such as Ranunculus ficaria (Pilewort), Hypericum perforatum (St. John’s Wort), Centella asiatica (Gotu Kola) and Witch hazel encourages healing of the perineal area, prevents infection and the formation of scars.
More Information on Episiotomy Healing
Tips for episiotomy healing
Aftercare and proper recovery is very important to relieve the pain and discomfort of an episiotomy.
- Add salt or lavender oil to your bath water for a soothing effect and to ease pain and discomfort
- Make sure that you cleanse the perineum area at all times, especially after using the toilet – use a squirt bottle filled with lukewarm water to the vaginal and rectal areas, then pat dry with a soft towel
- Apply cold packs or ice packs to the perineum area to reduce swelling
- Change maternity pads regularly
- Move around as often as possible to increase blood circulation and speed the healing process
- Keep the perineum area dry and wear cotton underwear
- Strengthen pelvic muscles by practicing Kegel exercises after you have healed
- Avoid lifting heavy objects or strenuous activity as the strain may cause bleeding and break the stitches