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What is an episiotomy?

 An episiotomy is a surgical cut that a Midwife or Obstetrician (a medical professional specialising in labour and childbirth) would make to your perineum, which is the area between your vagina and your rectum which you sit on.

 

Why are episiotomies given to women?

An episiotomy is given to a woman during childbirth so to make a bit more room for your baby to be born, but only when it is needed, which can be due to an assisted birth or if your baby needs to come out quickly. The cut enables the space for your baby’s head to emerge from to be enlarged and therefore prevent more damaging severe third and fourth degree perineal tears from occurring, which affect the rectum and anal sphincter.

If you need an episiotomy during childbirth, you will be offered pain relief, either a top up of your epidural or an anaesthetic. To help the episiotomy to heal you will be given stitches afterwards. It’s usually a straightforward procedure which Midwives and Obstetricians are very familiar with.

 

What are the reasons I might need an episiotomy?

If, during the birth of your baby, the Midwife or Obstetrician determines that your baby needs to be delivered imminently due to health reasons, either relating to your baby or you, they will consider giving you an episiotomy. This will usually because of one of the following reasons:

  • They need to use forceps or a ventouse to help you give birth to your baby (perhaps the baby is larger than average or it may have become tired)
  • Your baby is showing signs of distress as their heart rate is getting much faster or slower than expected, and so they need to be born quickly
  • You are exhausted from pushing during labour and have been trying to give birth for hours and are worn out 
  • Your baby is coming feet first as it is “breech”
  • You have a serious health condition and to minimise risks to your health your baby needs to be delivered quickly

 

Who will carry out an episiotomy?

Midwives and Obstetricians carry out episiotomies when women are delivering their baby and there is a need to get the baby out quickly or to reduce any health risks to the mum.

 

What is the difference between an episiotomy and a perineal tear?

A perineal tear happens spontaneously as the baby stretches the vagina during birth. Perineal tears have degrees of severity, with a 1st degree tear being the least severe and 4th degree tear being the most severe.

In comparison, an episiotomy is a cut made by a healthcare professional into the perineum and vaginal wall to make more space for your baby to be born.

Episiotomies are only done with your consent. The Midwife or Obstetrician carrying out the episiotomy will ask you before it is performed, that you are happy for it to be done.

If you have had an episiotomy, you will need stitches to repair it. You will usually be given local anaesthetic in the room where you had your baby and will be stitched by the health care professional.

 

How to heal after having an episiotomy

When you have given birth your body has done an amazing thing. However it does take its toll on your body physically.

In the region of 70% of women who give birth vaginally will have perineal tears and up to 10% have an episiotomy, and so it is important that your body can heal to enable you to get back to full health.

To help you to heal it is important to keep the area clean. Only use water to wash as soap can irritate the sensitive area.

Wash or shower at least once a day, and change sanitary pads regularly (every few hours in the first days after childbirth) because the lochia (bleeding after childbirth) is heavy.

You need to wash your hands both before and after going to the toilet or changing your sanitary pads. This will help to reduce the risk of infection.

Try to drink at least two litres of water every day and eat a healthy balanced diet including fruit, vegetables, cereals, wholemeal bread and pasta to help prevent constipation. This is important as straining when on the toilet can split your stitches and risks infection.

 

How long should it take for my episiotomy to heal?

After having an episiotomy, it is normal to feel pain or soreness for up to four weeks after giving birth, particularly when walking or sitting.

To help you to sit down after having an episiotomy or perineal tears there is now a specially designed postpartum cushion designed by Comfyse which you can sit on. It enables new mums to sit down after childbirth whilst alleviating perineal and anal discomfort thanks to its uniquely flexible shaping. The Comfyse Cushy Cushion is a perfect solution for new mums. You no longer need to suffer the perineal pain, instead you can sit comfortably and start to enjoy being mummy.

If you have also experienced perineal tearing, particularly 2nd, 3rd or 4th degree perineal tearing you will feel pain or soreness for longer, from two months to a year, and you may require surgery to repair the most severe of tears (please speak to your Midwife/GP about the medical support you need in such circumstances).

The stitches can irritate as healing takes place, but this is normal. Pouring body-temperature water over the area when urinating can help reduce your sensitivity and risk of infection.

The skin part of the wound where the episiotomy was carried out usually heals within four weeks of birth, and after that you should feel much less raw and tender. Thank goodness!

 

How to prevent tearing and the need for an episiotomy

Massaging your perineum during your pregnancy is thought to help stretch the muscles and skin in preparation for childbirth. There is no evidence of this helping to prevent tearing or the need for episiotomies, but many mums swear by it.

Using warm pads on the perineum during labour is thought to help prevent tearing and the need for episiotomies. The pads need to be pressed onto the perineum to help increase blood flow and relax the muscles around the vagina and anus.

 

 

When should I contact a healthcare professional?

Becoming a mum for the first time means that your life has changed, suddenly, and caring for yourself sometimes isn’t your priority as you feel that your baby is your number one priority.  However without a healthy mum, the baby will not be getting the best of you, and so you must seek help if something is not right, physically or mentally. If you’ve had an episiotomy or a perineal tear and

  • your stitches become painful
  • your stitches become smelly
  • your wound does not heal
  • you have any problems controlling your bowels, (perhaps you struggle to make it to the toilet or control wind)
  • you have any concerns

do get in touch with your Midwife, Health Visitor of GP.

 

It would be wonderful if women could deliver their baby vaginally without any physical issues occurring, however, as the reality is that most of us women will experience some form of perineal problems, we need to educate ourselves on how best to;

 1) prevent them occurring

 2) to manage them if they do occur

 3) how to heal after tearing

 4) recognise when there is a long term issue and who to talk to if we are not healing

 

I do hope that this blog has provided you with some useful information about what episiotomies are and how you can help yourself if you have one. Thanks for reading it.

 

Comfyse would like to help even more new mums to get comfy after childbirth. Do follow us and share @comfyse with your friends and family. Thank you lovely.

 

 

Disclaimer – the content here is not professional medical advice. Please seek medical advice from your GP Doctor or Midwife if you are concerned about any conditions you are experiencing during your maternity.

 

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