For years, almost every woman who had a vaginal delivery in a hospital received an episiotomy. An episiotomy is an incision in the tissue between the vagina and the anus, also known as the perineum. Doctors routinely performed episiotomies to enlarge the vaginal opening and assist the birthing process. Although not as common as they were in the '60s and '70s, it's still possible that your doctor may recommend one. Because of this there are things you need to know about episiotomies before going into labor.
I had to get an episiotomy with my first child due several factors including a large baby, the lack of pushing reflex due to opting for (AKA: begging for) an epidural, and most notably, the use of forceps to assist me in my delivery after my son got stuck in the birth canal. Those were fun times.
My episiotomy was pretty severe, and the healing process was probably the worst part of childbirth. Because of this, I asked my doctor to avoid cutting me if at all possible during my second child's birth. He agreed, and guess what? I only tore slightly, and my recovery was night and day from the first time around.
If you're getting ready to bring a little one into this world, here are some things you will definitely want to know about episiotomies.
1. Routine Episiotomies Are No Longer Recommended
There used to be a time when almost every vaginal birth was facilitated by an episiotomy. An episiotomy was thought to heal more quickly than a natural tear and preserve the muscular and connective tissue support of the pelvic floor, according to the Mayo Clinic. Recent research, however, suggests that routine episiotomies don't actually prevent these problems, and can make them worse.
2. An Episiotomy May Still Be Suggested By Your Doctor
According to Sanford Focus, your doctor may recommend performing an episiotomy if your baby is large, in distress, needs to be delivered quickly, in an abnormal position, or if extreme vaginal tearing is likely.
3. The Episiotomy Incision May Be Vertical
A midline or median incision is done vertically according to the Mayo Clinic. This kind of incision is the easiest to repair, but has a higher risk of extending into the rectum.
4. The Incision Can Be At An Angle
A mediolateral incision is on that is done at an angle. According to the Mayo Clinic a mediolateral incision offers the best protection from a tear extending into the anal area. However, it can be more painful and may be more difficult to repair.
5. Episiotomies Come With Risks
Risks of episiotomies include bleeding, tearing into the rectal tissues and anal sphincter muscle which controls the passing of stool, swelling, infection, collection of blood in the perineal tissues, pain during sex, and individualized risks according to your condition, according to Johns Hopkins Medicine.
6. Episiotomies Increase The Risk Of Tears In Subsequent Births
A Spanish study of 2,695 women delivering their second child found that they were at a greater risk of spontaneous tearing during childbirth if they had received an episiotomy during their first delivery.
7. An Episiotomy Is Repaired With Sutures
Episiotomies are repaired after the delivery of the placenta. According to Medscape, doctors will use dissolving sutures, so you won't have to get them removed. Baby Center suggested that sutures can take anywhere from a week to over a month to dissolve depending on the severity of the incision/tear.
8. Perineal Massage May Help You Avoid An Episiotomy
Although there is no hard evidence indicating that massaging your perineal region prior to childbirth will prevent you from tearing or needing an episiotomy, some doctors do believe that this practice can increase muscle and tissue elasticity in first time moms. You can find instructions for perineal massage at Midwife.org.
9. Tell Your Doctor If You Don't Want An Episiotomy
If you want to avoid getting an episiotomy, you should discuss it with your doctor prior to delivery and add it to your birth plan. In fact, Parenting recommends that when choosing a doctor you should ask what their rate of episiotomies is and under which circumstances they perform one. Remember, even if a doctor has a low episiotomy rate, they may still recommend one if there are extenuating circumstances.