When might an episiotomy be needed?
Today, only one in seven births require an episiotomy. An episiotomy is performed in the second stage of labor, once you start pushing the baby out and are very close to giving birth.
It is carried out if:
- the baby appears to be in fetal distress (that is, has a significantly increased or decreased heart rate and there is a real risk to the life or well-being of the baby if it is not born quickly)
- the doctor must use forceps or ventuose and this requires more space
- the baby is not born head first (that is, breech or face presentation)
- you had a long labor and you are tired
- big baby
- You have a serious health condition and if you don't push the baby out quickly, it could endanger your health.
When is an episiotomy necessary?
Episiotomy is aimed at reducing birth trauma, reducing the risk of bleeding and postpartum problems with urination and defecation, getting rid of pain after childbirth, but, at the same time, in some cases it itself contributes to the same problems.
Planned episiotomy was practiced for many years in different countries, but since the second half of the last century, obstetricians began to rapidly refuse to perform it, because an unnecessary surgical incision increases pain and prolongs recovery, leaving behind dense scar tissue, which subsequently disrupts sexual life.
If an episiotomy is still necessary, a mid-lateral incision is recommended to prevent injury to the rectum and its sphincter. The indications for episiotomy during childbirth are clearly formulated, although sometimes controversial, and the obstetrician must very quickly weigh the pros and cons and make a decision by choosing the optimal type of perineotomy. The reasons for surgical dissection of the perineum are:
- Significant risk of rupture of the perineal tissues of II and III degrees;
- The need to reduce the period of pushing due to pathology of the mother or fetus;
- Large fruit size;
- Density, inflexibility of the perineal muscles, which are unlikely to stretch or relax to the required extent;
- There were indications for the use of other obstetric aids (vacuum extraction, application of forceps);
- Weak attempts or their absence;
- Premature birth (to prevent injury to the baby);
- Previous female circumcision with scarring of the pelvic floor;
- Signs of intrauterine fetal hypoxia;
- Impaired exit of the baby's shoulders following the head.
How can I avoid the need for an episiotomy?
Perineal massage in the prenatal period. This is a way to help gently stretch and soften your perineum, preparing it for birth. Research has shown that perineal massage in the last five to six weeks of pregnancy reduces the likelihood of tearing, the need for an episiotomy, and pain in women who have not previously given birth vaginally.
During labor, it is important to remain as relaxed as possible in order to push the baby out without the need for intervention. Try different breathing techniques and birthing positions.
When is an episiotomy performed?
There are several reasons for this operation. I want to tell you about the most common of them:
- during childbirth, the vaginal walls cannot withstand the load (the fetus puts a lot of pressure on the tissue of the perineum, causing it to “uncork” - in this case an incision is made, because subsequently the vagina can tear like a “web”; such a tear is much more difficult to sew up than an incision after an episiotomy) ;
- labor has occurred prematurely and the labor of the woman in labor is too weak (in this case, an incision is made for a faster birth);
- labor takes a long time and doctors determine that the fetus does not have enough oxygen (the baby begins to choke), in which case they cut the perineum to use medical forceps.
One way or another, the decision to perform an episiotomy is made not by the woman in labor herself, but by the obstetrician. And such an operation is prescribed only when other methods to speed up labor do not help. It is important to accept the fact that a perineal incision is necessary to save the baby’s life or preserve women’s health.
How long does it take to heal?
To heal, your stitches should dissolve and the pain should improve within a month. By six weeks you should be sitting much more comfortably. To help your episiotomy heal faster:
- Keep it clean – You'll be wearing maternity pads for the next six weeks or so, but make sure you change them regularly to avoid infection.
- Let the air get to it - after a shower or when possible, lie down on a towel and let the air get to the area to help with healing.
- Sit on an ice pack – Wrap the freezer bag in a clean cloth or tea towel and then apply or sit on the area for a while to help reduce swelling and pain.
- Start pelvic floor exercises – this may be the last thing you want to do, but squeezing the muscles there can help get oxygen into the area and help with healing and tightening things up after birth.
Types of stitches after childbirth
Modern obstetrics identifies several classifications that divide sutures into different types depending on one or another characteristic. Thus, according to localization, it is customary to distinguish sutures that are applied for ruptures of the perineum, cervix, vagina, and labia. Separately, it should be said about the sutures that are placed during a cesarean section. The surgical technique involves layer-by-layer tissue restoration, that is, the uterus, its serous membrane, peritoneum, muscles, aponeurosis, subcutaneous fat and skin are sutured separately.
Based on the type of suture material used, it is customary to distinguish the following types:
- self-absorbing sutures after childbirth (usually catgut and vicryl are used for such sutures);
- non-absorbable (they are obtained if silk is used as a suture material).
Each type of thread has a certain period of resorption. How long does it take for stitches to dissolve after childbirth? Thus, vicryl is absorbed within 70-90 days, catgut - within 10-14 days, etc. Taking into account the resorption period, certain threads are selected that are necessary for matching tissues, that is, it depends on how long the sutures heal after childbirth.
For example, for ruptures of the labia, it is enough to use catgut, which quickly dissolves, since ruptures in this area heal quickly.
In case of perineal ruptures, it is advisable to apply longer-lasting absorbable sutures to the skin.
After an episiotomy: will it sting when you go to the toilet?
The idea of going to the bathroom after an episiotomy is not something that is easy to understand. You will most likely be afraid to do this the first time.
Unfortunately, it will sting at first, but there are a few tips to help you:
- Take a deep breath and then exhale as you pee
- Pour some clean, warm water onto the outer area of your vagina when you urinate to help with the burning sensation
- By squatting rather than sitting on the toilet, you can change the angle of your urine so it doesn't come into contact with your stitches
- Some doctors even recommend peeing in a warm shower to make it more comfortable.
When and where ruptures occur, and when is an episiotomy necessary?
Ruptures occur when the elasticity of soft tissues is reduced or the size of the fetus is large. The elasticity of tissues is genetic and can decrease due to inflammatory processes in the vagina (candidiasis causes inflammation of the mucous membrane of the vagina and vulva). Therefore, discuss the need for prenatal vaginal sanitation with your gynecologist in advance.
Rupture can occur in various places
- Cervix
- vaginal walls
- perineal tissue
To prevent deep tears, your doctor may decide to perform an episiotomy. It is also carried out if it is necessary to shorten the period of pushing (according to indications from the fetus or mother).
In this case, a surgical incision is made in the perineum from the commissure of the labia to the back, slightly at an angle (to the right or left). The procedure is unpleasant, but you can survive it. As is our custom, men discuss battle wounds and scars, and women discuss postpartum scars.
How to go to the toilet after an episiotomy?
If the thought of peeing after an episiotomy is hard, then what about going big.
The most common thing to worry about is that the push will somehow rip your stitches. This isn't really possible, so with that in mind, here are some helpful tips to help you through the process:
- If you pee first, squat down before sitting down.
- Take a maternity pad, fold it in half and (without the sticky part) use it to apply gentle pressure and protect your stitches while you poop
- Be careful when you wipe to avoid transferring bacteria
- If you're constipated and really having trouble passing, ask your doctor about using a laxative to soften your stools.
Caring for stitches after childbirth
How to treat sutures after childbirth, how to properly care for them? It all depends on where the suture is placed.
- External seams, that is, on the perineum and labia, must be treated in a special way.
- Internal sutures (these are ruptures of the cervix and vagina) do not require special treatment, the main thing is not to disturb them.
What does suture treatment look like after childbirth? One of the priority measures is observing the rules of personal hygiene. This means frequent changes of sanitary pads, which are necessary to absorb lochia, washing after each visit to the toilet. It is better to use a weak solution of potassium permanganate for these purposes.
Also, sutures on the perineum after childbirth must be treated three times a day using antiseptics.
For this purpose, sterile dressings and sterile instruments are used.
Typically, the process of treating sutures after childbirth is as follows:
- a woman’s genitals are poured with a solution of potassium permanganate;
- using a cotton ball on a forceps, treat with hydrogen peroxide in the direction from top to bottom, that is, towards the anus (the seams are no longer touched with this ball, you need to take a clean one);
- then you need to dry the seam. You can use either Betadine, brilliant green, or another drug.
After 10-14 days, with a smooth course of the postpartum period, the sutures must be removed, since by this time the wound has completely healed.
Removal of sutures after childbirth should also be performed using sterile instruments. This is a virtually painless process that does not require anesthesia. When the suture hurts after childbirth, it is recommended to use suppositories such as Diclofenac, which effectively eliminate pain.
In some cases, an intradermal suture may be placed on the skin of the perineum, which does not need to be removed. It resembles a cosmetic stitch.
Sex after episiotomy
Wait six weeks before being examined so your doctor can make sure it has healed. When you're ready to have sex, it may be uncomfortable at first, but it will get better over time. There should be no long-term pain associated with the episiotomy.
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Episiotomy concept
In layman's terms, episiotomy is used to prevent perineal ruptures during childbirth. That is, a pregnant woman is made an incision from the anus to the perineum.
This procedure is not something supernatural, and quite a few women in labor have experienced it themselves. There is no need to be afraid of such an operation at all, because it is completely natural and, with proper care after childbirth, heals relatively quickly.
There is also no need to think about cutting your skin. Episiotomy involves making an incision in the tissue of the perineum, rather than the skin in the intimate part.
