A surgical technique is done for widening the vaginal opening. The incision is made in perineal tissues between the anus and vagina mainly at the time of childbirth. 

Is episiotomy a painful procedure?

Episiotomy is done after giving local anaesthesia so that the woman does not feel the procedure or making of incision painful.

How is an episiotomy done?

Before the procedure, the woman is given local anaesthesia. Episiotomy is done by making a surgical incision or a cut through the perineal tissues between the anal region and vagina. The incision can be made straight at midline or an angle.

When it is necessary to opt for Episiotomy?

According to the NICE (National Institute for Health and Care Excellence), episiotomy is needed in the following conditions:

  • 1. In case the baby is distressed
  • 2. There is quick delivery required
  • 3. There is a risk of harsh or intense anal tear
  • 4. Forceps delivery
  • 5. Ventouse delivery
  • 6. History of perineal tear
  • 7. Maternal exhaustion
  • 8. Good size baby

Complications & Prevention

Complications include 

  • 1. Perineal laceration
  • 2. Episiotomy dehiscence
  • 3. Injuries in the bladder or urethra
  • 4. Haemorrhage
  • 5. Pain and Oedema at the wound site
  • 6. Infection in wound
  • 7. Damage to the rectal tissues and anal sphincter
  • 8. Perineal hematoma
  • 9. Anorectal dysfunction
  • 10. Urinary incontinence
  • 12. Sexual dysfunction

How do prevent the need for episiotomy?

To prevent the need for episiotomy, the following  measures should be taken

  • 1. Healthy diet: Good nutrition is the key to maintaining healthy skin and has a good ability to stretch more without much effort
  • 2. Pelvic exercises: Kegels are the exercise to strengthen pelvic floor muscles)
  • 3. Slowing down the pushing in the second stage of labour to have entire control over it.
  • 4. Do not lie on your back completely while pushing

Why episiotomy is not recommended by doctors anymore?

 There are certain reasons that episiotomy is not recommended by doctors: 

  • 1. Incisions made in episiotomy can become extensive 
  • 2. According to the recommendations of the American College of Obstetricians and Gynecologists, a routine episiotomy may cause more harm than natural tears during childbirth.
  • 3. WHO (World Health Organization) recommends episiotomy only in necessary medical conditions.
  • 4. According to research, there are fewer chances of infection and blood loss without episiotomy

What Measures can be Taken after Episiotomy?

Some of the measures that can be taken to heal after episiotomy 

  • 1. Do not use tampons till the healing of wounds
  • 2. Use an ice pack to reduce swelling 
  • 3. Take a warm water bath that completely submerges the genitals in warm water for a while
  • 4. Numbing sprays can be used to prevent itching and pain
  • 5. Take a pain reliever to ease pain and discomfort.
  • 6. Use clean pads to relieve irritation.
  • 7. Use doughnut pillows to sit.

Classification of Episiotomy

Different kinds of episiotomy

  • 1. Median episiotomy
  • 2. Modified median episiotomy
  • 3. ‘J’-shaped episiotomy
  • 4. Mediolateral episiotomy
  • 5. Lateral episiotomy
  • 6. Radical lateral 
  • 7. Anterior episiotomy

Episiotomy Indication

Indications of episiotomy

  • 1. Forceps delivery – the type of delivery that uses a forceps instrument to guide the delivery of the baby.
  • 2. Concerns with Fetal heart Monitoring (FHR) – FHR concerns include obese mother, baby’s position, etc.
  • 3. Ventouse delivery – method of delivery that requires assistance in childbirth
  • 4. Vaginal breech – bottom of the baby gets delivered first instead of head
  • 5. Previous experience of perineal tear
  • 6. Maternal exhaustion – prolonged labour for more than 2 hours
  • 7. Rigid perineum- too tight perineum create issues with normal delivery
  • 8. Good size of the baby

Frequently Asked Questions

Is an episiotomy painful?

No, episiotomy is not painful as it is done after providing local anaesthesia to the patient. 

Is episiotomy necessary for normal delivery?

No, episiotomy is not necessary for normal delivery of the baby. Sometimes, it may become necessary but not in the case of all normal deliveries. Certain conditions like the baby’s distress and fear of anal tears make the episiotomy procedure be opted to prevent further complications related to childbirth.

Is episiotomy better than tearing?

No, largely episiotomy is not better than natural tears. Episiotomy has more chances of developing infections that are rare in the case of a natural mild tear.

How long does episiotomy take to heal?

Episiotomy takes at least a week to heal. It depends on the type and extent of incision made and stitches after the procedure. In some women, there is a minute incision that heals quickly while in others the larger or deep incision takes more time to heal.

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