It shortens the time to delivery. The rapid descent of the baby with vacuum or forceps delivery often causes laceration or tearing of the vaginal opening. In these cases, an episiotomy may prevent excessive tearing. Shoulder dystocia is a problem that can occur when delivering large babies. This complication is common in women who have diabetes, but can occur in any woman delivering a large baby. An episiotomy allows more room for the shoulders to pass through.
Vaginal deliveries may result in long-term complications, including relaxation of the vaginal walls. This can cause the bladder, cervix, uterus, or rectum to bulge through the vaginal wall. If an expecting mother insists on a vaginal delivery following pelvic reconstructive surgery, an episiotomy may facilitate the delivery and prevent further damage to repaired areas. This position, called the occiput anterior presentation, allows the smallest diameter of the head to pass through the vaginal opening and makes for an easier, quicker delivery.
In cases of occiput posterior presentation, there is more likely to be significant vaginal trauma during the delivery. An episiotomy may be required to enlarge the vaginal opening. During delivery of multiple babies, an episiotomy allows additional room at the vaginal opening for delivering the second twin.
In cases where both twins are in a headfirst position, the doctor may slow delivery of the second twin by performing an episiotomy. In a situation where the first twin is delivered normally and the second twin must be delivered from a breech position, episiotomy allows adequate room for the breech delivery. 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.
The advantages of a midline episiotomy include easy repair and improved healing. This type of episiotomy is also less painful and is less likely to result in long-term tenderness or pain during sexual intercourse. There is often less blood loss with a midline episiotomy as well. The main disadvantage of a midline episiotomy is 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. In a mediolateral episiotomy, the incision begins in the middle of the vaginal opening and extends down toward the buttocks at a degree angle.
The primary advantage of a mediolateral episiotomy is that the risk for anal muscle tears is much lower. However, there are many more disadvantages associated with this type of episiotomy, including:. Episiotomies are classified by degrees that are based on the severity or extent of the tear:. Although an episiotomy is necessary for some women, there are risks associated with this procedure.
Possible complications include:. An episiotomy is usually repaired within an hour after delivery. Wear sanitary pads. Do not douche or use tampons until your doctor says it is okay. Ask your doctor when it is okay for you to have sex. You can eat your normal diet. Drink plenty of fluids unless your doctor tells you not to. If your bowel movements are not regular right after surgery, try to avoid constipation and straining.
Drink plenty of water. Your doctor may suggest fibre, a stool softener, or a mild laxative. Your doctor will tell you if and when you can restart your medicines.
He or she will also give you instructions about taking any new medicines. If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do. Be safe with medicines. Read and follow all instructions on the label.
If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
Put ice or a cold pack on the sore area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
Sit in a few centimetres of warm water sitz bath 3 times a day and after bowel movements. The warm water helps with pain and itching. It may feel better to dry the area with a hair dryer instead of a towel. After you use the toilet, pour or spray warm water over your vagina and anus. This will help keep the area clean. After a bowel movement, it may feel better to wipe with baby wipes or medicated pads, such as Tucks.
For example, call if: You passed out lost consciousness. Call your doctor or nurse call line now or seek immediate medical care if: You have severe vaginal bleeding.
This means you are passing blood clots and soaking through a pad each hour for 2 or more hours. You are dizzy or light-headed, or you feel like you may faint. You can often reduce this discomfort by using a covered ice pack for the first day or two—especially if the wound is still swollen and red.
The skin in this area is sensitive. Some new moms prefer soaking a large sanitary napkin in witch hazel, freezing it, and then applying it to their underwear to provide comfort. The most important thing is to keep your perineum clean. Starting as soon as you get home, use a squirt bottle filled with warm water to cleanse the area every time you use the bathroom. Pat the area dry rather than wiping to prevent tugging the stitches.
Here are some other useful tips for keeping the area clean:. You will typically have your stitches checked at your 6-week postpartum visit.
At this appointment, your doctor or midwife will also tell you when you can resume sexual relations and can provide guidance for dealing with incontinence or any other postpartum issues you might be experiencing. If you are experiencing issues like incontinence or continued pain, your healthcare provider might recommend Kegel exercises to help restore muscle tone around the perineum.
As with all surgical procedures, infection is possible following an episiotomy. Call your doctor or go to the emergency room if you experience an infection such as:. Keep in mind that in addition to infection, there are other complications that can occur after an episiotomy—some of which can be serious.
If you have any unusual or concerning symptoms, or even if you just have questions about aftercare, don't hesitate to contact your healthcare provider. Get it free when you sign up for our newsletter. Kettle, C. Cochrane Database of Systematic Reviews. National Library of Medicine.
Episiotomy after care. Updated April 18, Rev Bras Enferm. Frohlich J, Kettle C. Perineal care. BMJ Clin Evid. Published Mar Steen M, Cummins B. How to repair an episiotomy.
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