What is Episiotomy: Procedure, Advantages and Complications

Giving birth is a beautiful journey, but it can also be physically demanding. One potential medical intervention performed during childbirth is an episiotomy - a procedure that widens the vaginal opening for the baby's smooth delivery. This procedure, once a routine practice, now raises several questions: is it truly necessary, and what are the pros and cons to consider?

This blog will discuss episiotomies, exploring their purpose, types, advantages, and potential complications. Keep reading to learn more about this aspect of childbirth.

What is an Episiotomy?

An episiotomy is a medical procedure where a small incision is made by your doctor (or obstetrician) in the perineum, the area between the bottom of the vaginal opening and the anus, during childbirth. The purpose of an episiotomy is to widen the vaginal opening and ease the baby's delivery. \

In some cases, the perineum may tear naturally during the baby’s delivery - a process known as a perineal tear or laceration.

While the episiotomy procedure prevents severe tearing during childbirth, it's not performed routinely anymore. Most doctors prefer natural tearing unless specific medical reasons, including prolonged labor, fetal distress, or large baby size, may arise.

What are the Indications for Episiotomy?

Episiotomies are less common than before, and doctors usually allow natural tearing during childbirth. However, there are certain situations where the procedure might be necessary.

Some of the common indications for episiotomy include:

• Your baby is in distress and requires immediate delivery.
• Prolonged labor has left you tired and dehydrated.
• Your baby's delivery will require the use of forceps or a vacuum by your doctor, and to utilize these tools, they might need to widen your vagina.
• Your baby is in a breech position (feet or buttocks first) or experiences shoulder dystocia (an obstetric emergency where your baby’s shoulders get stuck in your pelvis).
• Your baby's size is larger than usual.
• You've been pushing for an extended period or are having difficulty controlling pushing.

How is the Episiotomy Procedure Done?

During a normal delivery process, your doctor carries out an episiotomy procedure. The specific procedure may vary based on your condition and doctor; however, the general process usually goes like this:

• To ensure you do not experience pain, you'll receive anesthesia. If you already have an epidural to numb the lower part of your body, you'll likely not need additional anesthesia. However, if not, your doctor will inject a local anesthetic into the perineum.
• When your baby's head reaches your vaginal opening (the crowning stage), exerting pressure on the perineum, your doctor will use special episiotomy scissors to make a controlled incision in the perineum.
• After the incision, your beautiful baby will be delivered, then the placenta.
• Finally, your doctor will carefully stitch the episiotomy and surrounding tissues using dissolvable stitches. They'll also assess the degree of the tear and ensure there are no complications.

What are the Types of Episiotomy?

There are two main types of episiotomy performed during childbirth:

1. Median (Midline) Episiotomy:

This procedure involves a vertical incision (made up and down), running from the vaginal opening towards the anus.

Pros:

• Easier and faster to perform.
• Less bleeding compared to mediolateral incisions.

Cons:

• Higher risk of tearing the anal sphincter or rectum, which can cause long-term problems with bowel control.
• May cause more pain and discomfort during recovery.

2. Mediolateral (Diagonal) Episiotomy:

This type of incision is an angled or diagonal incision made at a 45-degree angle from the vaginal opening towards the buttock.

Pros:

• Lower risk of tearing into the anal sphincter or rectum than midline incisions.
• May offer more room for vaginal delivery and reduce the need for further interventions.

Cons:

• More challenging to repair for doctors, leading to longer surgery times.
• May cause more blood loss during surgery.
• Recovery can be more painful and uncomfortable due to the larger area involved.

The choice between the types of episiotomy is made by your doctor based on several factors, such as your anatomy, the baby's position, and your labor's progress. Your doctor will weigh the pros and cons of each option to identify the safest and most effective approach for your situation.

What are the Advantages of Episiotomy?

Here are some of the advantages:

• Episiotomies offer a more controlled and deliberate cut during natural birth, which reduces the risk of uncontrolled tearing.
• In some cases, episiotomies can speed up the birthing process, especially when a quick delivery is essential for the baby's well-being.
• Controlled incisions may result in less trauma to the perineal area than spontaneous tearing.
• This procedure may prevent more extensive tears that can be challenging to repair.

What are the Complications of Episiotomy?

Here are some of the complications:

• Bleeding
• Infection
• Painful sexual intercourse (dyspareunia)
• Damage to the rectum and anal sphincter
• Swelling
• Extended recovery time
• Severe scarring that could require a period of non-sexual activity.
• Potential issues with urine incontinence

How Much Time Does It Take for an Episiotomy to Heal?

While most episiotomy healing processes take around a month, the period can vary based on the type and severity. Natural tears generally take a similar time to heal.

You can expect some pain and soreness in the first few weeks, and discomfort during sex might occur (when approved by your doctor). Keep your doctor informed about your recovery and pain levels. They can assess if everything's progressing normally based on your specific situation.

How Can I Recover After an Episiotomy?

After an episiotomy, you can experience soreness in the perineal area for a few weeks. To reduce discomfort, follow these tips:

• Use a perineal cold pack or ice pack to reduce swelling.
• Take warm sitz baths for healing and temporary pain relief.
• Employ a "peri bottle" with warm water for bathroom use.
• Apply numbing sprays for pain and itching.
• Consider OTC pain relievers (e.g., acetaminophen or ibuprofen) as advised by your doctor.
• Use witch hazel pads to soothe and relieve irritation.
• Sit on a donut pillow to ease pressure on the perineal area.
• Consult your doctor for guidance on recovery activities, and avoid tampons, sex, or vaginal insertions until approved by your provider.

When to See a Doctor?

If you've undergone an episiotomy procedure, you should seek medical help under the following conditions:

• If the pain persists and worsens rather than improving.
• If pus flows out from the incision or if your discharge smells foul.
• If the skin surrounding the incision shows signs of redness or swelling.
• If you are experiencing bleeding at the site of the incision.
• If you develop symptoms such as fever, chills, or body aches.

Which is Preferable, Natural Tearing or Having an Episiotomy?

Episiotomy was once widely performed in childbirth by doctors who believed it could prevent severe tears and complications like urinary incontinence and pelvic floor dysfunction. However, in 2006, the American College of Obstetricians and Gynecologists (ACOG) advised against the routine use of episiotomy. Research has shown that episiotomies do not effectively prevent severe lacerations and may result in more extensive tearing. Moreover, they do not prevent complications such as urinary or bowel incontinence or painful intercourse when compared to natural perineal tears.

Conclusion

Episiotomy procedure is a delicate decision in childbirth. While it offers some potential benefits, natural tearing is often preferable due to lower complication rates and similar healing times. Ultimately, the decision rests with you and your doctor, ensuring the safest and most comfortable birthing experience for you and your baby.

Remember to communicate with your doctor openly throughout pregnancy to ensure a safe and comfortable delivery experience.