What every woman should know about episiotomy

Episiotomy: Procedure,  reasons,  complications,  wound care, and healing.

Ladies, you’ve probably come across the term ‘Episiotomy’ or you’re clueless about what an episiotomy is. Let’s face it; you don’t want to even think of having your vagina cut. Unfortunately, it’s something you need to know about before you go into labor.

An episiotomy isn’t something you can plan for. So you may be wondering why you need to learn about it.

Episiotomy
An episiotomy
The reason is informed consent, because an episiotomy is a surgical procedure that often has to be performed in emergency situations or at the height of labor. Both of these are situations which leave you unable to think straight or take important information on board.
If you know about them beforehand, you are more likely to understand what is happening and the effect it may have on you.
So, what is an Episiotomy?
It is a surgical cut in the muscle area between the vagina and the anus (the area called the perineum) just before giving birth to increase the vaginal opening. Your caregiver repairs the cut with stitches after your baby is born.

Reasons why you may need an Episiotomy may include…
1. Delayed second stage of Labour.
The second stage is when you dilate to 10cm, and your baby is ready to be born. This part is when you start to push with each contraction. The 2nd stage can last a long time if your perineum is holding your baby back. An episiotomy releases the resistance on the baby’s head and provides more room for baby to be born. In this situation, to justify an episiotomy when your baby is distressed, or you have been pushing for at least an hour.
2. Shoulder Dystocia
This is an emergency situation where your baby’s head delivers but the shoulders stay stuck in the pelvis. An episiotomy won’t help deliver the shoulders, but it can make room to perform maneuvers that will
Other possible reasons are:
3. If we require tools to help deliver the baby for example, vacuum delivery.
4. If the baby is breech.
5. If you are having a twin delivery or more.
6. If you are having a big baby.
7. If the baby’s head is not well positioned.
8. To prevent perineal tear.
Complications
* If done by an inexperienced personnel could cause vaginal damage which will in turn weaken that area for future births. That means you are at higher risk of tearing and requiring stitches.
* If an episiotomy extends, it can cause anal trauma and you may be advised to have a C-section for future babies.
* It’s also common for an episiotomy to result in reduced sensation or increased pain during sex. Reluctance and fear to have sex can lead to massive strain on relationships.
* After the cut and  the baby has been born, pain meds would be prescribed and  administered, you may still feel some level of pain depending on your threshold.
* Very few women develop episiotomy scar.
Note that the benefits when indicated far outweighs the above complications.
Care of the episiotomy wound
* Whatever you do, do not touch your stitches or just simply do not touch that area at all. Touching it may cause it to develop an infection.
* Do not bend over or lift heavy objects.

* An ice pack will be placed over the area to reduce pain and swelling, always keep the area dry to avoid it becoming infected.

* Sitz baths are important in reducing infection, a bowl of lukewarm water with salt added to it, then you are required to sit in this bowl for about 20 minutes 3 to 4 times in a day.

* Do not apply hot water to the repaired  episiotomy wound,  it may melt the absorbable stitches and cause the wound to breakdown.

* AVOID having sex for 4 to 6 weeks until your doctor tells you it is ok to do so. This is to allow it time to fully heal.

Healing

The healing process takes time and patience. It will not take longer than 2 weeks that’s for sure, so you can breathe now. But it does take time for your body to feel and maybe look back to where it used to be. Just relax, enjoy being a mom and time will definitely 100% heal it.

However, if you notice any discharge from the area, please see your doctor, it is possible that the wound is infected.

Kindly share with others.

Chima Ihueze MD

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