An episiotomy — a surgical incision in the perineum during childbirth — was once a standard delivery practice. Now, practitioners recognize that it's not necessary for most births. In fact, allowing mom to tear naturally can result in less blood loss, pain, and risk of infection. The fact that episiotomies aren't routine, however, doesn't mean they don't happen. In certain scenarios, such as fetal distress, they're practically unavoidable. In the interest of avoiding surprises, I'm sharing the things I wasn't prepared for when I had an episiotomy.
Having an episiotomy was never part of my plan. I'd done the research, and found out that it can actually cause tearing (all the way to the rectum which is, you know, ouch!) and lead to incontinence. No thanks. It was something I wanted to avoid, so I wrote in my birth plan that I preferred to tear naturally. My team of midwives was totally on board and gave me some tips for avoiding tearing. However, you know what they say about the best laid plans...
When it was time for me to start pushing, my nurse noticed that my daughter's heart rate kept dropping. She and the midwife suspected a compound presentation (baby girl had her hand next to her cheek). It was time to call in the head honcho obstetrician. (Like, the one with her picture on the wall). All of a sudden, there were 12 people in the room where before there had only been three. The doc took one look at me and determined that the baby needed to come out now-ish. It was all so fast, but in the end, I had a vacuum-assisted birth and, you guessed it, an episiotomy.
Because I assumed I'd be able to follow my birth plan (silly rabbit), I was unprepared for all that a surgical cut to my vagina would entail. Here's what surprised me most:
That The Doctor Wouldn't Ask Me First
Excuse me? You mean you don't have to ask my permission before cutting me in the grundle? Apparently not. I guess things just escalated quickly. I know the OB's priority was getting my baby out safely, so I can't really blame her. I have since learned that an episiotomy is part and parcel of performing a forceps or vacuum delivery. Still, it was a bit of a shock not to be informed, especially when I'd specifically requested to avoid one if at all possible.
That I Wouldn't Feel It In The Moment
I received an epidural after 20 hours in labor. I was feeling my contractions, and I definitely felt my baby crown. But the episiotomy? I didn't feel a thing. I didn't even know it had happened. When the nurse handed the doctor a needle and thread, I wondered what the hell she was doing. When I asked if I'd torn, that's when I found out she'd made an incision.
That I'd Be Sewn Up Before I Delivered The Placenta
Speaking of things I didn't know were happening: when the doctor began the repair of the episiotomy, it occurred to me that I didn't remember delivering the placenta. I knew that some women basically sneezed the thing out, so I wasn't too worried.
Enter midwife: "Time to push again!" I was pretty pretty sure there wasn't another baby in there. It just seemed totally counterintuitive to me to be stitched up when something still had to come out, but that's precisely what happened!
That It Would Burn Like A Thousand Hellfires Postpartum
I may not have felt anything during the procedure itself, but that first night after my baby was born, I thought I was dying. My friend describes the feeling as "like being stabbed in the vagina." For me, it was a super intense burning sensation. It was so bad it woke me up, and I actually pressed the call button. I didn't like how "out of it" the Percocet made me feel, but I took two that night.
That My Lady Parts Would Never Be The Same
I'm not saying everything down there is ruined, but I have definitely considered total perineum replacement surgery.* My midwife said that it healed like a dream, but I've definitely taken a hand mirror down there to check it out for myself. I still have a faint scar line, but there's also this weird little nubbin. It' not causing me any problems, and I already have skin tags from my hemorrhoid surgery, so I guess what's the difference if they have another friend down there?
*That's not actually a thing.
That The Stitches Dissolve
Where do they go?
That "Perineal Care" Was A Thing
It takes about seven to ten days for an episiotomy to heal. It's a freshly repaired wound, and it has to be cared for that way. Which is cool, because it's not like you're also trying to take care of a helpless newborn or anything. A few things you can do in your spare time:
- Keep it clean. You're going to bleed, so make sure you change your pad. Use those puppy pee pads they give you in the hospital.
- Ice it. Your nurse will give you a magical icepack maxipad. Watch and learn.
- Use a doughnut-shaped pillow. (You already have one because of those hemorrhoids, right?)
- Do your Kegels. No really. Do them.
- Consider trying local anesthetics, witch hazel pads, and pain relief medication.
- And my personal favorite...
That A Sitz Bath Would Be My Best Friend
Make the time for this one, and go ahead and get the kit. A sitz bath is a little plastic bath that fits on your toilet seat. You fill an IV-type bag with warm water, and you use a clamp to cycle in fresh warm water. It's basically waterboarding the vagina, and it's awesome.