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Everything You Need To Know About An Episiotomy

Episiotomy is a surgical procedure performed just before delivery to help expand the vagina without any difficulty. In this procedure, doctors make a small incision (3 - 5 cm) in the region between the vaginal opening and the anus (also known as the perineum). Though developed in Ireland in 1974, episiotomy found worldwide recognition from the mid-1990's.

Vaginal tears are common during childbirths. At times, the vaginal tear can be severe and extensive, resulting in extreme discomfort. Complications at a later stage cannot be ruled out either. An episiotomy is recommended to avert the situation. Chances of an injury (mild to severe) during childbirth can be minimized with an episiotomy. It is recommended in cases where:

1. The pregnant woman is stressed out and faces difficulty in pushing out the baby.

2. Fetal macrosomia (the baby is quite large) with strong chances of extensive vaginal tearing during delivery.

3. A critical condition of the mother or the baby or both that requires a quick delivery.

4. The baby is not positioned right (breech position) inside the womb.

5. Severe shock or trauma to the perineal region.

The episiotomy incisions can be mediolateral or midline (median)

The mediolateral incision: In this case, the incision is made diagonally, extending from the center of the vaginal opening, moving outwards towards the ischial tuberosity (tuber ischiadicum). The incision represents a typical 6 o'clock position.

The mediolateral incision minimizes the chances of perineal tears (especially the third and fourth-degree tears) and damages to a great extent.

The mediolateral incision has some demerits

1. It causes considerable blood loss and bleeding.

2. More often than not, the healing process is painful.

3. The incision can result in scarring.

4. There is difficulty in wound repair and healing.

Midline or median incision

As the name suggests, the incision is at the midline, from the vaginal opening and extending till the anus.

In median incision

1. The incision is simple and performed without any difficulty.

2. The bleeding is less as compared to a mediolateral incision.

3. The repair is simple and easy.

4. Unlike mediolateral incision, there is comparatively less pain and scarring when one does a midline incision.

With merits come the demerits

The third and fourth-degree perineal tear can occur in the case of midline incision.

In the third-degree tear, apart from the perineal tear, the anal sphincters are partially or completely ruptured.

In the fourth-degree tear, in addition to the complete perineal tear, the anal sphincters and the rectal mucosa are also damaged.

Episiotomy- Its merits and demerits
Merits:

1. Episiotomy comes as a much-needed relief for women who have difficulties and complications during childbirth.

2. The surgical procedure minimizes the chances of tissue injury considerably.

3. The surgical incision is easy to repair.

4. The healing is comparatively less painful.

5. The childbirth is hassle-free.

6. Episiotomy helps to accelerate the delivery process in case of fetal distress.

7. It is a blessing in disguise for pregnant women who encounter difficulties in pushing the baby out during delivery.

Demerits:

With the good comes the bad. Likewise, episiotomy comes with its share of demerits.

1. An episiotomy can result in third-degree and fourth-degree perineal tear. The damage is, thus, more than apprehended.

2. There will be bleeding and blood loss.

3. One may experience painful intercourse long after the childbirth.

4. The healing may take time.

5. There are chances of scarring at the incision site. In extreme cases, there may be scar endometriosis.

6. There may be infection, pain, and swelling at the site of the wound or incision.

Recuperating from an episiotomy

In the case of an episiotomy, it takes 6-8 weeks for the wound to heal. The following steps can help accelerate the healing process.

1. Painkillers (as prescribed by the physician) can be used to get some relief. 

2. Right posture for a quick healing is advisable. Use a pillow while sitting. It is important to tighten the buttocks when one bends down to sit.

3. Soothe the icy way by applying a cold compress or ice packs at the site of the incision, as this can prove to be helpful.

4. Keep the wound well-covered and padded during the bowel movement. There should be minimum stretching. 

5. Avoid constipation, as it can prove to be a nemesis in the healing process.

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