Episiotomy

Episiotomy
Approved by the BabyCenter Medical Advisory Board

--------------------------------------------------------------------------------
What's below:
• What is an episiotomy and why is it done?

• Are there reasons not to have one?

• Will I be able to choose whether to have one?

• Will it hurt?

• Can it affect when I can have sex again?

• See also | Other Sources
--------------------------------------------------------------------------------


What is an episiotomy and why is it done?
An episiotomy is a surgical cut in the perineum, the muscular area between the ****** and the anus, that's often done with a local anesthetic. Though an episiotomy doesn't have to be a routine part of labor, your medical practitioner may give you one to speed delivery and prevent your ****** from tearing as your baby is born. Many practitioners believe that the planned incision of an episiotomy heals more easily than the tears that can happen spontaneously during delivery, but this is not always true.
Though episiotomies are often standard procedure, they have lately become controversial as some compelling new studies question their effectiveness and necessity. Research has also shown that episiotomies can lead to more serious lacerations than those sustained by women who deliver without being cut.



Are there reasons not to have one?
Yes. A 1994 Canadian study found that spontaneous tears were less painful for women than episiotomies. In addition, women who avoided an episiotomy had stronger pelvic floor muscles three months after giving birth.
A more recent Canadian study, published in April 2000, found that women who didn't have episiotomies fared as well as or better than those who did, especially when it came to urinary incontinence, pelvic floor problems, and tearing of the perineum. The study also found no difference in the rate of incontinence among women who've had episiotomies and those who haven't, and that women who weren't surgically cut actually had less infection and pain after delivery.

Numerous studies have concluded that episiotomies should not be done without a good medical reason because serious possible complications — such as rectal injury and sphincter muscle damage — can outweigh the short-term benefits.

Episiotomy extensions or tears that go through the rectum (known as fourth-degree lacerations) require a significantly longer recovery period, involve more perineal pain after the birth, and are more likely to affect the strength of pelvic floor musculature. And because a tear into the rectum disrupts the anal sphincter, some women also have problems with incontinence of feces or gas.

Will I be able to choose whether to have one?
Though some physicians routinely perform episiotomies, particularly with a first birth, they are certainly not inevitable. You should absolutely let your doctor or midwife know your preference. Try to discuss the pros and cons of this procedure with your healthcare provider at a prenatal appointment. Ask how often your doctor or midwife is able to deliver a baby without giving the mother an episiotomy.

Ask your practitioner if she performs perineal massage to help avoid episiotomies and if she has any suggestions for you, such as breathing techniques to control the urge to push too soon. In England, women typically labor lying on their side, which tends to slow the process and allow the perineum time to stretch.

Will it hurt?
Sometimes an episiotomy can be performed virtually pain-free during pushing when the perineum is already quite numb from the stretching and pressure of the baby's head coming out. If the procedure is done before the area is numb, you should be given a local anesthetic injection to ensure that you won't feel anything when the incision is made. But the aftermath and the healing can be quite painful. Be sure to use ice packs in the perineal area immediately after birth. The ice will numb the area and prevent or reduce swelling.

While you're healing, sit delicately — on one buttock, if possible; it takes the pressure off the perineum. Remedies that can speed healing and ease soreness include:

• Warm soaks in a sitz bath or in the tub, after 24 hours. They're soothing and relaxing.

• Exposing the wound to air as much as possible, and keeping it dry. After showering, hold a blow dryer set on warm 10 to 12 inches away from the area until dry.

• Walking and doing Kegel exercises to stimulate circulation and speed healing.

• Applying compresses (cotton pads soaked in witch hazel) to the affected area.

• Numbing sprays, available in the hospital.

Can it affect when I can have sex again?
Your bottom should be completely healed around four to six weeks postpartum, so if your caregiver gives the okay, and you're up to it, you can resume sex then. You might feel some initial tenderness and tightness. Try having a glass of wine, taking a warm bath, and leaving plenty of time for foreplay. You might prefer to be on top so that you can control the degree of penetration, or find that lying on your side is most comfortable.

Relaxing as much as possible and using a good lubricant such as Astroglide or K-Y Jelly will help make lovemaking more comfortable the first few times — or longer, if you're breastfeeding, when low hormone levels reduce the amount of lubrication your ****** can produce. Many women continue to use a lubricant during sex until they stop nursing.

On babycenter, you should check it out, chock full of stuff. I just love to share it here for us to have some place to find it with ease.

How can I avoid an episiotomy?

Expert: Suzanne Powell, ICCE [See Biography]

Question: I really don't want to have an episiotomy when I deliver my baby. Is there anything I can do in preparation for labor that will help me avoid one?
Suzanne Sherwood Powell, ICCE: Starting around the 34th week of your pregnancy, you could try daily prenatal massage of the perineum (the area around your ******). Perineum massage may increase the stretching ability of the area, leading to less need for episiotomy and fewer natural tears. (Editor's note: There isn't any hard evidence that this technique will help you avoid an episiotomy or make any real change in the flexibility of the skin in this area. But it can't hurt if you want to try. )

With clean hands and trimmed nails, try this technique yourself, or have your partner do it for you. If you do it yourself, have a large mirror handy as well, to help familiarize yourself with your perineal area:

• Sit in a warm comfortable area, spreading your legs apart in a semisitting position. Put Vitamin E oil (from punctured Vitamin E capsules) or pure vegetable oil on your fingers and thumbs and around your perineum.

• Place your thumbs about 1 to 1 1/2 inches (to or just past your first knuckle) inside your ****** and spread your legs. Press down toward the rectum and toward the sides at the same time. Gently and firmly continue stretching until you feel a slight burn or tingling.

• Hold this stretch for about 2 minutes--until the tingling starts to subside.

• Now slowly and gently massage the lower part of the ******l canal back and forth, hooking your thumbs onto the sides of the ******l canal and gently pulling these tissues forward, as your baby's head will do during delivery. Keep this up for 3-4 minutes.

• Finally, massage the tissues between the thumb and forefinger back and forth for about a minute.

• Do be gentle, as a vigorous touch could cause bruising or swelling in these sensitive tissues. During the massage avoid pressure on the urethra (urinary opening) as this could induce irritation or infection.

Of course, perineum massage is not for everyone and it may not help in every case. The most important thing you can do is to choose a midwife or doctor who is experienced and comfortable delivering babies without cutting an episiotomy. In general, midwives tend to perform this surgery much less often than physicians. Regardless of the type of practitioner you choose, you should certainly discuss your wishes and expectations with that person before the birth.

I will have to go see. You are the best Shamma.

You gots the baby fever baby!!! DUST to you and Roger.

Thanks Jen, I guess the readiness feeling is more like it, even tho some days I change my mind and some days I am all excited and ready again

What are the advantages and disadvantages of an episiotomy?

Expert: Ann Linden, Certified Nurse-Midwife [See Biography]

Question: What are the advantages and disadvantages of an episiotomy?
Answer: There are many disadvantages to episiotomy and few advantages per se, although there are times when it may be recommended. In the United States, episiotomy is the most common operation in obstetrics; in many U.S. hospitals, the majority of first-time mothers get episiotomies, although there are no scientific data to support its routine use.

It has long been thought that episiotomy prevented trauma to the perineum and improved the long-term function of the pelvic musculature. However, recent studies have shown that this is simply not true. Episiotomies do not prevent pelvic floor relaxation and do not prevent serious perineal damage. In fact, research shows that midline episiotomies tend to increase the average depth of perineal injury and substantially increase the risk of damage to the anal sphincter and the rectum (which can cause a lot of discomfort and, at times, long-term problems, such as anal incontinence). Besides increasing the incidence of serious lacerations, episiotomy is associated with increased pain postpartum, increased sexual discomfort when intercourse is resumed, and increased blood loss at the time of delivery.

Some women who do not receive an episiotomy will end up with spontaneous perineal lacerations, but studies have shown that, in general, these women also experience less pain after delivery and stronger pelvic floor musculature at three months postpartum than women who underwent episiotomies.

An extensive study reported in the September 1994 American Journal of Obstetrics and Gynecology by Michael Klein et al. concluded that 'episiotomy should be reserved for specific fetal and maternal indications' and that the 'current practice of use of episiotomy at routine and high rates should be abandoned, and methods for protecting and preserving the perineum intact, or with small perineal tears, should become a formal part of medical education.'

That said, there are times when performing an episiotomy is justified. Delivering a baby over an intact perineum requires slightly more time during the second stage of labor (the pushing stage), as the midwife or doctor must allow adequate time for the mother's ****** and perineum to gradually stretch. Occasionally, the fetus simply cannot tolerate the extra time needed for the ****** to stretch naturally, and an episiotomy is used to expedite delivery.

Episiotomy is also used when more room might be needed for manipulation, such as for a ******l breech delivery or the delivery of a very large infant. In addition, an episiotomy is often performed before the application of forceps or a vacuum extractor. On rare occasions, the maternal tissue is either so swollen or otherwise compromised that it cannot stretch well and episiotomy is needed. However, these indications do not occur in the majority of labors and can't explain the unconscionably high rate of episiotomy seen in most American hospitals.

If you'd like to avoid an episiotomy, it's important to speak to your healthcare provider early on about your feelings regarding the procedure. Also, ask your care provider about her experience delivering babies over intact perineums and the episiotomy rate in the practice. Studies show that, as a group, midwives tend to do far fewer episiotomies

This sentence:

Some women who do not receive an episiotomy will end up with spontaneous perineal lacerations, but studies have shown that, in general, these women also experience less pain after delivery and stronger pelvic floor musculature at three months postpartum than women who underwent episiotomies.

describes MY personal experience to a 'tee,' except that I only had one small tear - not multiple tears.

'or have your partner do it for you.'


DH WOULD JUST LOVEEEEEEEEEE THAT!
lol

Shamma .... thanks so much for finding this info & sharing!! Its (obviously!) been on my mind lately & the girls were so helpful in yesterday's post, but this is great!!!

Can always count on you! Tons & Tons of baby dust !!!!

shamma- HAVE A LITTLE BABY! LOL!

All preggy women should also warn their husbands of an episiotomy!!!!Especially if they are going to be in watching the delivery! That was the only thing that I didnt warn Brian about and that was the only thing he was freaked out about!

And if you have one- DEFINATELY do your Kegels!!!

Kegels, kegels, I agree kegels. Thanks for all the baby dust ladies.

Christine when I saw this I thought of you and had to post it for you Anytime it is always my pleasure

OMG!!

I'm gonna buy a chastity belt!