Everything you wanted (or didn’t want) to know about an episiotomy

I found this one of the significant questions I had towards the end of my pregnancy. Did I request to be cut to avoid a tear? It was such a difficult decision. Who knew whether I was going to tear anyway? And how do you decide without all the information?

Well, let’s get into a discussion on episiotomy.

What exactly is an episiotomy

Simply put, it’s a cut made to the perineum (the area between the vagina and the anus) and underlying muscles. The aim is to make your vagina wider for your baby to be born more quickly and easily.

There are two types of cuts. A midline runs straight from front to back. And a mediator cut starts from the midline point but then goes to one side to avoid the anus.

Why would one woman need an episiotomy when another doesn’t?

Some OBs perform episiotomy’s as standard practice. So if you are adamant against one, you should ask your OB what their percentage of episiotomies performed is.

Medically, the arguments in favour for an episiotomy are to:

  • prevent a tear in the perineum that is difficult to stitch,
  • make it easier to deliver your baby,
  • allow for a forceps delivery.

What’s better: tear or cut?

There is lots of research and arguments out there for and against both camps. Essential the consensus are that if it’s a small tear that is not going to go through several layers of muscle. Then tearing is better. These tiny tears will heal quickly and are not likely to involve stitches.

Larger tears, especially where they are ragged and go through multiple layers of muscle are going to be more difficult to stitch, and therefore a cut would make more sense.

The problem is, you don’t know which you will be until it happens. So you are trying to answer the impossible question!

Both sound painful

The first thing you should know is that many women tear (even if just a little bit) during birth. After all my weeks of agonising about whether to allow a cut, I ended up with minor first-degree tears in both of my drug-free births. And you know what, I had no idea it had happened until the midwife told me. Ohh and the first time I had to pee!

I can’t speak from experience about being cut, so I asked friends. And the consensus is that with everything that was going on, they had no idea either until someone mentioned they needed stitches.

Logically, it shouldn’t hurt as you are given a local anaesthetic before the cut is made.

Will the stitches hurt?

Firstly, your caregiver is unlikely to stitch you up until after you have birthed your placenta. And that may sting a bit. Once the placenta is out, you will be given another local anaesthetic before the doctor starts stitching. Stitching takes a long time as the doctor has to stitch layer by layer; vaginal skin, muscle, and perineum skin.

You will be really uncomfortable or even in mild pain for the first week or two after the birth of your baby. When you get tired, your stitches are likely to ache, so rest as much as you can. And lay down as much as you can to take the pressure off your perimeum.

Ice condoms work a treat. If you haven’t heard of this before, it’s where you half fill a condom with water and tie them off loosely. Then freeze them. This will allow for a popsicle type object to wrap in cloth and place between your legs. So that the coolness helps your stitched area. Ice condoms also work a treat for haemrrhoids.

Avoid constipation like the plague

You are unlikely to burst your stitches when having a bowel movement. But there’s no point causing yourself extra pain either. Eat a fibre rich diet and drink plenty of water. If you are concerned, lubricate your anus with olive oil before you need to poo.

How long does it take to heal?

About 4 or 5 weeks. I know. It’s just another thing women have to deal with. Big hugs! 

I really really really don’t want one.

There are things you can do:

  • Remember to start massaging the perineum during the last month of pregnancy. Making it as supple and stretchy as possible.  Your caregiver will give you instructions on how to do this.
  • You might consider training with an Epino.
  • Listen to your midwife when she asks you to breathe through the ring of fire.
  • Birth in an upright or semi-upright position. Standing and squatting takes the pressure off the perimeum.

Hi! Natural Birth and Motherhood is about empowering women who are going through the stages of pregnancy, birth, or motherhood. Find out more useful information on related topics click on the Blog button below.

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