What is Episiotomy?
An episiotomy is a procedure of making an incision to excise the tissue connections. This incision occurs in females between the anus and the vaginal opening during childbirth. The region where the incision is made is called the perineum.
Types Of Episiotomy
Depending on the type and angle of incision made; episiotomy is of two types
The incision can be made vertically and eventually easier to repair than midline incisions. It is risky because it may extend more towards the anal area.
The incision that is made at an angle is mediolateral. It does not have a high risk of getting abnormally extended, but its repair process is comparatively difficult and painful.
Lateral excision begins from a thin skin fold of the vulva called the fourchette. This type of incision poses a risk to Bartholin’s duct.
The J-shaped incision begins from the centre of the vulval skin fold to the posterior midline and then downwards, making a J- shape. The procedure is not much used or recommended by the experts.
The episiotomy procedure is undertaken by an obstetrician (expert in caregiving to pregnant ladies and delivering babies). They make a minute cut from the vaginal opening to the anal region so that the vaginal opening becomes wider to deliver the baby.
Advantages Of Episiotomy
Various advantages of episiotomy are
- 1. Easier delivery of the baby
- 2. Comparatively lesser blood loss
- 3. Improved process of healing
- 4. Improved sexual experience
- 5. Less pain
- 6. Severe laceration or vaginal tear is prevented
- 7. Delivery of baby gets speed up
Risk Factors Of Episiotomy
There are certain risks of episiotomy.
- 1. Bleeding due to incision
- 2. Swelling around the anal or vaginal region where an incision is made
- 3. Incision might get infected
- 4. Blood may get collected inside the perineal tissues
- 5. Intercourse might get painful
- 6. Tearing of rectal tissues or muscles of the anal sphincter.
- 7. Infection.
- 8. Blood collection in perineum
- 9. Pain during sex
Complications arising due to episiotomy
- 1. Perineal laceration
- 2. Episiotomy dehiscence
- 3. Stitches getting worsened
- 4. Haemorrhage
- 5. Oedema at the wound site
- 6. Infection in wound
- 7. Damage to the rectal mucosa
- 8. Damage to the Anal sphincter
- 9. Urethral injury
- 10. Bladder injury
- 11. Perineal hematoma
- 12. Intense Pain
Serious complications arising due to episiotomy
- 1. Chronic pain
- 2. Highly complicated infections
- 3. Linear scar
- 4. Anorectal dysfunction
- 5. Prolapse
- 6. Sexual dysfunction
- 7. Urinary incontinence
Degree of Episiotomy
- 1. First-degree episiotomy
- 2. Second-degree episiotomy
- 3. Third-degree episiotomy
- 4. Fourth-degree episiotomy
The first-degree incision is the cut made only in the epithelial tissue of the vaginal lining.
The second-degree incision is made in the perineum muscles going through the anal sphincter.
The third-degree incision is made by passing the perineal muscles and anal sphincter.
Fourth-degree incision occurs beyond the muscles, sphincter and inner rectal lining.
Recovery Of Episiotomy
Recovery time varies in women from a few weeks to a month. It depends on the degree of incisions made or the episiotomy.
After the procedure of episiotomy that has been done for easier delivery of the baby, the doctors repair it afterwards by stitching and closing the wound. The stitches made to heal the episiotomy are clear and easily dissolvable.
There are important measures to be taken after episiotomy.
- 1. Change pads after intervals of 2- 4 hours
- 2. Keep the area around stitches clean and dry
- 3. After taking a bath, dry the area with a clean, soft towel or baby wipe
- 4. To maintain hygiene, spray warm water on stitches and clean them regularly
When To See a Doctor
An expert or doctor consultation becomes essential.
- 1. If the wound seems painful for a longer period
- 2. In case of excessive bleeding from the wound
- 3. If you observe red and swollen skin surrounding the incision
Frequently Asked Questions
Why is episiotomy not done anymore?
There are numerous valid reasons why episiotomy is no longer chosen as a procedure. The main reason is that it worsens the situation after childbirth. According to various case studies, many women experience harsh tearing after the procedure compared to natural vaginal tears that occur during the baby’s delivery.
How painful is an episiotomy?
Episiotomy is the procedure of making an incision after giving local anaesthesia to make the localized surgical site numb. It won’t be painful after providing proper anaesthesia in the perineum.
Is episiotomy better than tearing?
According to various studies, there have been cases where there are worsening conditions and eventual complications after episiotomy. The situation has been compared with natural vaginal tearing because of childbirth, which shows relatively less blood loss and chances of infections are almost negligible.
In some cases, the reverse situation has also been observed wherein surgical cut has successfully prevented issues arising from harsh natural tears.
How long does episiotomy take to heal?
The incision made as a procedure called episiotomy gets repaired in an hour or less, while the healing of stitches may take a few weeks to a month for the healing process.
What are the risks associated with episiotomy?
Some of the risks associated with episiotomy
Bleeding – The incision made between anus and vaginal opening normally heals but there may be excess bleeding from the wound.
Swelling- Swelling of the wounds surrounding the episiotomy incision can get worse along with redness.
Infection- The wounds or incision of the episiotomy procedure might get infections due to unhygienic conditions.
Which is worse: C-section or episiotomy?
C- Section or cesarean delivery is the surgical procedure involving incisions on the abdomen and uterus to deliver the baby. This process is worse in terms of cuts or incisions compared to episiotomy. C-section is chosen in case of serious pregnancy complications where there is no other way.
D- Cesarean is a high-risk surgical procedure to deliver the baby compared to episiotomy. Episiotomy is low risk and easy-to-go procedure followed for childbirth.