All You Need To Know About Episiotomies

Written by Eve Bandusena | Parents Avenue’s Editorial Assistant

Image Source: Istock

While it used to be routinely common in the past during delivery, episiotomies in the modern times are only recommended in specific cases and conditions. Read on to find out all about episiotomies and find out if it could be applied to you!

What Is An Episiotomy?

An episiotomy is a surgical incision made in the perineum, which is the area of tissue between the vagina and anus. The cut in this area is done to widen the vaginal opening before delivering your baby.  

In recent years, there’s been a sharp decrease in episiotomies due to its contribution to worsening the tearing that occurs in natural childbirth. Although vaginal tearing is an inevitable byproduct for women who deliver vaginally, it can usually be considered as a minor injury to the vaginal tissue and doesn’t require stitches, however, there are more severe tears that are deeper than that involve the vaginal tissue with the anus and rectum.

Before this, many medical health professionals believed that creating a small cut at the perineum would make stretching a lot easier. But today, we understand that an episiotomy incision can rip to a larger a tear that could’ve been avoided, smaller in size and shallow in depth had the tear happened without an episiotomy. For all mothers-to-be, the probability of an episiotomy occurring is stated below:

 An episiotomy has more likelihood in happening if:

•    Delivering your first baby

•    Using forceps or vacuum birth

•    Experiencing a long second stage

•    Having an epidural

•    When your baby’s head is in an atypical position

•    The baby is bigger than usual in size

An episiotomy has less likelihood in happening if:

•    Delivering your subsequent baby

•    Perineal massage has been done in the late stages of pregnancy

•    Your pelvic floor is relaxed

•    When you’re birthing the baby’s head slowly between contractions

•    If you deliver your baby at a baby center or home

Types of Episiotomy 

There are two methods of episiotomy, Midline Episiotomy, and Mediolateral Epistionomy as described on Healthline below:

Midline Episiotomy

In a midline episiotomy, the incision is made in the middle of the vaginal opening, straight down toward the anus. 

The advantages of a midline episiotomy include easy repair and improved healing. This type of episiotomy is also less painful and is less likely to result in long-term tenderness or problems with pain during sexual intercourse. There is often less blood loss with a midline episiotomy as well.

The main disadvantage of a midline episiotomy is the increased risk for tears that extend into or through the anal muscles. This type of injury can result in long-term problems, including fecal incontinence, or the inability to control bowel movements.

Mediolateral Episiotomy

In a mediolateral episiotomy, the incision begins in the middle of the vaginal opening and extends down toward the buttocks at a 45-degree angle. 

The primary advantage of a mediolateral episiotomy is that the risk for anal muscle tears is much lower. However, there are many more disadvantages associated with this type of episiotomy such as increased blood loss, increased pain, difficult to repair, and high risks of long term discomfort, especially during sexual intercourse.  

 

Image Source: Medindia
Classification of Episiotomies
  
There is 4 classification of episiotomies which is based on the severity of and extent of the tear. Below are the categories for episiotomies:
 
First Degree: The tear only penetrates the vaginal lining.
 
Second Degree: Inarguably the most common type of episiotomy, the tears penetrate the vaginal lining and the underlying vaginal tissue.
 
Third Degree: The tear not only extends through the vaginal lining, but also the vaginal tissues, and part of the anal sphincter.
 
Fourth Degree: This type of tear is the most severe, it extends the vaginal lining, vaginal tissues, anal sphincter, and the rectal lining.
 
Dr. Shimatul’s Experience With Difficult Deliveries
 
“I’ve seen and handled cases with difficult deliveries with extended or deep tear but with good cooperation from everyone (and of course, with meticulous repair) the outcome was excellent and successful.”  Dr. Shimatul Aida, O&G at Gleneagles Kota Kinabalu shares.
 
Image Source: Istock
Causes for Episiotomy
 
It is important to note that episiotomies are not recommended in case of spontaneous vaginal delivery. However, the procedure can be done in the following conditions:
 
•    Prolonged labor
 
When fetal distress occurs, which involves maternal weariness and a prolonged second stage of labor, an episiotomy can be used to quicken the duration of the vaginal delivery. Once the baby reaches the vaginal opening, extra space for the head of the baby to pass through can be done by undergoing an episiotomy.
 
•    Helps with vaginal childbirth
 
When vaginal deliveries are assisted using vacuum extraction or forceps, episiotomies ease the procedure by minimizing the resistance and subsequently cause less force to a baby’s head. With the quick pull of the baby using forceps delivery or vacuum, deep cuts may occur at the vaginal opening, but if one employs an episiotomy procedure, the serious tearing can be avoided.
 
•    Baby in breech presentation
 
When a baby is in a position of breech presentation (typically when a baby’s bum area goes through the cervix before the baby’s head) performing an episiotomy will present more additional room to move around and the usage of forceps will be able to be introduced to help deliver the baby’s head.
 
•    Delivering a large baby
 
A problem that occurs with the delivery of large babies is shoulder dystocia, meaning, a baby’s shoulders become stuck at the birth canal. Aside from women delivering large babies, women living with diabetes also experience this problem. Using an episiotomy will create additional room for the baby’s shoulders to pass through.
 
•    Atypical baby’s head position
 
At times, a baby’s will be in an atypical position. Several examples of this include when a baby’s head is moved slightly towards one side, focused directly at one of the mother’s hips or faced towards the mother’s belly button, a rather great amount of diameter of the baby’s head will be needed to go through the birth canal.  
 
•    Twin deliveries
 

When delivering more than one baby, having an episiotomy will allow added room at the vaginal opening for the deliverance of the subsequent baby. In instances where twins are in a head-first position, an episiotomy may be done to slow down the delivery of the second twin. In other situations, when the first twin has a normal delivery, the second twin will most likely be delivered in a breech position. Episiotomies will allow room for the delivery.

 Recovering from Episiotomy
 
 The good news is Dr. Shimatul relays that healing from episiotomies has a very good success rate. “With good perineal and hygiene care, episiotomies recover very well,” she adds, “I wouldn’t recommend applying anything at the wound except for clean water and clean sanitary pads at the site.” 
 
After delivery, the episiotomy is repaired within an hour. In the beginning, the incision will bleed moderately but will stop once the wound is closed with sutures. Sutures will then dissolve with time and you won’t have to return to the hospital. 
 
When you’ve had an episiotomy, it’s quite normal to feel discomfort and pain around the area of the incision for two to three weeks. For women with third or fourth-degree episiotomies, the duration of healing will take a longer time. 
 
For women who have gone through episiotomies, the pain will be more markedly evident when they undergo normal movements such as walking, sitting and urination. To lessen the pain, a few steps can be taken as listed below:
 

•    Placing a cold pack on the perineum

•    Using lubricant during sexual intercourse

•    Taking pain medication such as stool softeners

•    Sitting down in a sitz bath
 
•    Using a squirt bottle instead of toilet paper 
 
“All in all, don’t be afraid of episiotomies. Have an open mind and rest assured that you and your health is good in the hands of your carer.” Dr. Shimatul adds at the end.
 

Disclaimer: This article is not intended to diagnose, treat, cure, or prevent any diseases. At Parents Avenue, we strongly recommend all our readers to seek medical advise from your local hospital or clinic. Thank you. 

 
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