Episiotomy helps to prevent severe vaginal tears- ”A stitch in time!”

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Episiotomy
An episiotomy is a surgical incision made in the perineum, the area between the vagina and anus. Episiotomies are done during the second stage of labor to expand the opening of the vagina to prevent tearing of the area during the delivery of the baby. This procedure may be used if the tissue around the vaginal opening begins to tear or does not seem to be stretching enough to allow the baby to be delivered.

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It is used to be a normal part of childbirth, but it has become much less common in recent years. In the past, an episiotomy was done to help prevent severe vaginal tears during delivery. It was also believed that an episiotomy would heal better than a natural or spontaneous tear.
More recent research, however, suggests that an episiotomy may actually cause more problems than it prevents. The procedure can increase the risk of infection and other complications. Recovery also tends to be lengthy and uncomfortable.

The following are some of the conditions that may necessitate episiotomy during child birth:
Evidence of maternal or fetal distress
The baby is premature or in breech position, and his/her head could be damaged by a tight perineum.
The baby is too large to be delivered without causing extensive tearing.
The delivery is being assisted by forceps.
The mother is too tired or unable to push.

Existing trauma to the perineum.
Types of Episiotomy
The two most common types of episiotomy are midline episiotomy and mediolateral episiotomy.
In a midline episiotomy, the incision is made in the middle of the vaginal opening, straight down toward the anus. It is easy to repair and healing is faster. It is also less painful and is less likely to result in long-term tenderness or problems with pain during sexual intercourse. Blood loss is often minimal with this type. Its shortcomings include 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 bowl movements.

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On the other hand, mediolateral episiotomy is the incision that starts from 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, the disadvantages associated with this type of episiotomy, including: excessive blood loss, severe pain, difficult repair, higher risk of long-term discomfort, especially during sexual intercourse.
Classification of Episiotomy
Episiotomies are classified according to the depth of the incision:
A first-degree episiotomy cuts through skin only (vaginal/lierineal).
A second-degree episiotomy involves skin and muscle and extends midway between the vagina and the anus.
A third-degree episiotomy cuts through skin, muscle, and the rectal sphincter.
A fourth-degree episiotomy extends through the rectum and cuts through skin, muscle, the rectal sphincter, and anal wall.

Diagnosis/Preparation
Although there are some reasons for anticipating an episiotomy before labor has begun (e.g. breech presentation of the baby), the decision to perform an episiotomy is generally not made until the second stage of labor, when delivery of the baby is imminent. After delivery, the vagina and perineum are cleaned and carefully examined. In most cases, the episiotomy will only affect the lining of the vagina and the tissue directly below the vagina. However, when the episiotomy extends into the anal sphincter or the rectal lining, these wounds will be repaired first.
All repairs are performed with suture, or surgical thread, that absorbs into the body and does not require removal. Thin sutures are used to close the rectal lining, while larger and stronger sutures are used to repair the anal sphincter. After the rectal lining and the anal sphincter have been repaired.

Post Episiotomy life
It is usually repaired within an hour after delivery. The incision may bleed quite a bit at first, but this should stop once your doctor closes the wound with sutures. Since the sutures dissolve on their own, you won’t need to go to the hospital to have them removed. The sutures should disappear within one month.
It is normal to feel pain around the incision site for two to three weeks after an episiotomy. Women who have third- or fourth-degree episiotomies are more likely to experience discomfort for a longer period of time. The pain may become more noticeable while walking or sitting. The pain can be relieved by:
applying cold packs on the perineum
using personal lubricant when having sexual intercourse taking pain-relieving medications using a squirt bottle instead of toilet paper to clean yourself after using the toilet.
The incision should be completely healed within a month or one and half months after delivery. The recovery time may be slightly longer if you had a third- or fourth-degree episiotomy.



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