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What Is An Episiotomy, Really?

by Yvette Manes

You have probably heard your mom or some friends complaining about having to get an episiotomy while delivering their babies, but what is an episiotomy, really? I am so glad you asked. Although you will probably cringe more than once while reading this, being educated will help you avoid, or at the very least understand, this once routine medical procedure.

According to the Mayo Clinic, an episiotomy is an incision made in the tissue between the vagina and the anus in order to enlarge the vaginal opening and facilitate childbirth. This area is known as your perineum. As Dr. Ashley Briggs, an OB-GYN with Sanford Obstetrics and Gynecology Clinic in Sioux Falls, explained in Sanford Focus, the episiotomy was once a routine part of childbirth thought to help prevent more extensive tears of the vagina, allow for faster healing, and prevent the bladder and rectum from dropping. However, research has suggested that recovering from an episiotomy may actually be more painful than recovering from a natural tear.

Because of this, most doctors today reserve episiotomies for cases in which the baby is very large, is in an abnormal position, or is in distress and a quick delivery is necessary.

The Mayo Clinic additionally explained that an episiotomy can be performed in one of two ways. A midline or median episiotomy is a vertical incision that is easiest to repair, but has the greatest risk of tearing down to the anus. The mediolateral episiotomy is done at an angle and offers the greatest protection against and extended tear reaching the anus, it is also the most painful and hardest to repair. The episiotomy is repaired after the delivery of the placenta using sutures that dissolve.

According to Baby Center, the pain of recovery can last as long as a month after delivery depending on the severity of the incision. Johns Hopkins Medicine recommended using an ice pack to reduce swelling and pain. Doctors typically recommend sitz baths (warm shallow baths) to cleanse the perineum, ease soreness and speed healing. You can also talk to your doctor about using medicated creams, numbing sprays, or taking over the counter pain relievers.

There are also risks associated with an episiotomy. According to Johns Hopkins Medicine you can be at risk for rectal tearing, issues with the anal sphincter muscle which controls the passing of stool, swelling, infection, and the collection of blood in the perineal tissues.

If an episiotomy doesn't seem like your cup of tea, tell your OB-GYN prior to delivery that you want to avoid it if at all possible, and make sure to add it to your birth plan.