Episiotomies

Midwife Elizabeth Stein answers the question, Will I need to have an episiotomy?

Question

What is an episiotomy, and is it something I can avoid?

Answer

An episiotomy is a straight surgical cut into the perineum. The perineum is the area between the back of the vagina and the rectum. An episiotomy allows more room for your baby to come through by enlarging the opening.

There are some instances when an episiotomy is a reasonable choice -- if your baby is very large, if your baby is in distress and needs to be delivered quickly, or if forceps are needed. Some doctors perform episiotomies as a routine procedure, because suturing a straight cut is easier than repairing a jagged tear (laceration). But most lacerations are small and not difficult to repair, whereas some episiotomies result in additional tearing, extending into the rectal muscle and the anus. These deeper tears have the potential to create long-term problems for the mother.

Most women would prefer not to have a routine episiotomy. The most effective way to avoid an episiotomy is to talk to your midwife or doctor. Ask what her philosophy is regarding protecting the perineum. Some perform routine episiotomies, some perform them only for specific reasons, and others brace the perineum or use lots of lubricant (such as K-Y Jelly) while the head is crowning. After delivery, they suture any small tears. Small tears are very common with first babies. You should be proactive in stating your feelings, but it's important to understand that this can be a last-minute, split-second decision. You need to have confidence in your midwife or doctor.

During your pregnancy, prior to delivery, you or your partner can massage your perineum gently with a water-soluble lubricant. Factors that affect the strength and elasticity of the perineal tissue include general health and nutrition as well as vaginal infections. Gentle, controlled pushing while delivering the baby's head may also prevent tears.

Genital/perineal tissue has a very rich blood supply so healing will occur without much help in three to six weeks. Applying an ice pack to the perineal area as needed for the first 24 hours will decrease pain and swelling. It's best to keep the area clean and dry. Wash with water and mild, white soap. Change your sanitary pad frequently and use topical sprays and ointments as much as necessary. Fill the peribottle with cool water and run the water over your genital area when you urinate. This will help decrease the burning sensation. While these suggestions won't make the episiotomy or tear heal any faster, you will feel more comfortable. You should continue to take a shower, rather than a bath, until your six-week checkup, or for as long as you have bleeding or discharge from the vagina. Discuss this with your midwife or doctor at your postpartum checkup.

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

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