Definition An episiotomy is a cut made to widen the opening of the vagina. It is done toward the end of labour to keep the vaginal tissues from tearing as the baby is born. Sometimes an episiotomy is done to deliver the baby quickly if the baby is in distress.
Who is a candidate for the procedure? Usually, the doctor or midwife attending the birth decides whether to do an episiotomy. An episiotomy is usually done when:
the vagina cannot stretch enough to allow the baby to pass through
a baby is thought to be large (more than 9 pounds)
forceps or vacuum must be used to help in the birth
monitors show that the baby is in distress or not getting enough oxygen and needs to be born quickly
the vaginal opening starts to tear as the baby's head appears
the baby's shoulder is in a position that blocks the birth canal (shoulder dystocia)
How is the procedure performed? As the crown of the baby's head pushes through the vaginal opening, an anaesthetic is injected to numb the perineum, the skin between the vagina and anus. A cut of 5cm - 7.5cm is made there. After the baby is born and the placenta is delivered, the cut is stitched up absorbable stitches.
What happens right after the procedure? Most episiotomies are done to prevent large vaginal tears during childbirth. These tears heal slowly, often with poor results. Widening and tearing of the vagina may cause unnecessary stretching. This may later lead to problems such as:
urinary incontinence, or being unable to hold urine in the bladder
a prolapsed bladder, in which the bladder sags down into the wall of the vagina
a prolapsed rectum, in which the rectum sags down into or through the vagina
An episiotomy may help to prevent these problems.
What happens later at home? Keeping the area clean is the key to preventing infection and to help speed healing. The stitches do not need to be removed. The stitches will dissolve after a period of time.
To help heal an episiotomy, a woman should:
take sitz baths or sit in a tub of warm water a few times a day. Wash the area gently with a stream of water after using the bathroom.
relieve pain and swelling with ice packs. Sitting on an inflatable donut helps, too.
avoid constipation to keep this tender tissue from stretching too much. Take stool softeners, such as metamucil, and drink 8 to 10 glasses of fluids every day.
use over-the-counter pain relievers, such as paracetamol as needed.
avoid sexual intercourse for 6 weeks after the birth.
A woman should see her doctor for follow-up visits to check on how the episiotomy is healing.
What are the potential complications after the procedure? Very rarely, an episiotomy may extend into the rectum. More stitches than usual would be required to repair the cut. The increased risks of this problem are:
infection
bruising
a fistula, or hole between the vagina and rectum
Author: Eva Martin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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