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MoonDragon's Women's Health Procedures Information
EPISIOTOMY
(Perineotomy)


For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.




Attention Readers: I am presenting this from a medical standpoint, not necessarily one from a midwife's standpoint. However, I will try to include information and links that may assist with presenting the pros and cons of this controversial procedure. Most midwives I know, including myself, take great pride in our very, very, low episiotomy rates and our ability to assist the mother in giving birth over an intact perineum with few, if any, tears or abrasions. If repairs are necessary, we also take extreme care in making sure that any repairs are performed properly, expertly matching tissues with appropriate tissues, providing sterile techniques to prevent infections, and careful instructions on postpartum care. Even most first time mothers are fully capable of birthing their babies without this procedure when allowed enough time and support by a competent birth support provider.


  • Episiotomy Description
  • Reasons For Episiotomy
  • To Suture or Not To Suture
  • Episiotomy Risk Factors
  • Episiotomy Procedure Description
  • Episotomy Expected Outcome
  • Episiotomy Complications
  • Episotomy Post Procedure Care
  • Medication
  • Activity Recommendations & Restrictions
  • Diet & Nutrition
  • Notify Your Health Care Provider




  • EPISIOTOMY DESCRIPTION

    An episiotomy, also known as a perineotomy, is an incision at the exterior of the vaginal opening into the peritonium (area between the vaginal opening and the anus) to create enlargement.

    Obstetricians used to cut episiotomies routinely to speed delivery and to prevent the vagina from tearing, particularly during the first vaginal delivery. Many experts believed that the "clean" incision of an episiotomy would heal more easily than a spontaneous tear. But a great many studies over the last 20 years of so have disproved this theory. Most experts now agree that the procedure should not be done routinely.

    Research has shown that women with spontaneous tears generally recover in the same time and often with fewer complications than those with episiotomies. Women who have episiotomies tend to lose more blood at the time of delivery, have more pain during recovery, and have to wait longer before they have sex without discomfort.

    Women who get episiotomies are more likely to end up with serious tears through the anal sphincter or even all the way through the rectum (known as third- or fourth-degree lacerations, respectively) than those who deliver without being cut. These serious tears result in more perineal pain after the birth, require a significantly longer recovery period, and are more likely to affect the strength of the pelvic floor muscles. And tears that disrupt the anal sphincter increase the risk of anal incontinence - trouble controlling bowel movements or gas.





    REASONS FOR EPISIOTOMY PROCEDURE

    This procedure is usually performed during childbirth, just before the widest diameter of the baby's head passes through the outlet of the birth canal. This allows easier passage of the baby's head to reduce the potential damage to the mother's vagina, bladder and rectum (however, studies have shown otherwise... this is a medical surgical procedure that has been greatly over-used and over-abused. Midwives have shown that most women can give birth, vaginally, without tearing or needing to have an episiotomy).

    This procedure also helps expedite delivery in the case of forceps or vacuum use when there is maternal exhaustion or fetal distress when the baby's heart rate shows that he/she is not tolerating the last minutes of labor well and needs to be born as quickly as possible.

    Some practitioners will perform an episiotomy when they feel the baby's head is large or may not be molding enough to pass through the vaginal opening or if they feel they need a little extra room to manipulate the baby to get him/her to come out.

    Some practitioners will use this procedure if the woman's tissue is starting to bleed or looks like it is about to tear in multiple places as the baby's head begins to crown. The idea here is that being cut in one place is better than tearing in more than one place. However, a few shallow tears may still be preferable to an episiotomy, so your health care provider or midwife will have to make a judgment call.

    AVOIDING AN EPISIOTOMY

    Talk to your health care provider or midwife early in your prenatal care about your feelings regarding the procedure. Ask him/her how often and under what conditions he/she would perform an episiotomy, and how she might help you to avoid tearing during the delivery. If you are in a group practice, make sure you discuss your concerns with other practitioners in the practice, in case you end up with someone else at your delivery besides your own health care provider. Studies show that, as a group, midwives tend to do far fewer episiotomies than do other health care providers, especially obstetricians, which seem to have the highest rate of surgical intervention.

    Perineal Massage: Start doing daily perineal massage about 5 to 6 weeks before your expected delivery date. A few studies show that perineal massage may make it less likely that you will tear or need an episiotomy. Your midwife should be able to tell you how to do proper perineal massage for the best benefits.

    MoonDragon's Pregnancy Information: Episiotomies - What You Should Know





    TO SUTURE OR NOT TO SUTURE

    Determination of whether to suture or not is the next consideration. Some situations have been mentioned as things that should NOT be sutured: labia tears close to the urinary meatus or clitoris, skid marks which are like scrapes. Beyond this, assessment and decisions to suture or not to suture need to be made. The woman has the right to say if she does not want to be sutured, but she will also be depending on the experience of the midwife to help her make that decision. Some things which would make the decision to suture more likely might be:
    • The woman wants them.
    • The laceration is ragged and does not close together when legs are placed together.
    • The laceration is extensive, externally or internally.
    • The woman needs more than 2 stitches to close the laceration.
    • A new laceration probably needs sutures for best healing.

    Some things which might help decisions against sutures might be:
    • The woman does not want them.
    • The laceration edges are straight and close together well when legs are closed.
    • The laceration is shallow and not extensive.
    • The laceration is along an old episiotomy scar (where it will probably be very straight and close well).
    • She needs less than 2 stitches to close her up.
    • She has been closed up during a former birth in what turned out to be an uncomfortable way (that infamous "extra stitch" commonly given by male physicians, tightening the vaginal opening for the sexual pleasure of the woman's husband), in such cases healing is often better with no sutures at all, as long as the damage is not extensive. (Ask the woman.)

    Ultimately, the midwife and the woman must come to a decision based upon the midwife's knowledge and the woman's desires.





    EPISIOTOMY RISK FACTORS

  • None expected. However, further tearing may occur beyond the incision which may involve more extensive repair.





  • DESCRIPTION OF EPISIOTOMY PROCEDURE

    An incision is made in the perineum just before the widest part of the baby's head is to be delivered. The size of the incision depends on how large an opening is required for the baby's head to pass through safely.

  • An injection of local anesthetic may or may not be given prior to the procedure. Sometimes, if your perineum is already numb and thinned out from the pressure of your baby's head, she may be able to do the episiotomy without pain medication. This is sometimes called a pressure episiotomy.
    >
  • The incision is usually made using surgical scissors to make the small cut. The surgical scissors preferred have a blunt end on one side (this side goes into the vagina) to prevent injury to the vaginal tissue and the baby's head during insertion and cutting.
  • The baby and placenta are delivered.

  • After the baby and placenta are delivered, you may get another shot of local anesthesia to be sure you are completely numb before your health care provider or midwife stitches up the cut. Note: if the cut is very small, requiring only a few superficial sutures, local anesthetic may not be necessary and may actually be a hindrance since it can cause tissue swelling and allergic reactions in the mother. The repair of a superficial cut or tear without anesthetic feels like a little "pinch" and can be done. I have had it done on myself and I have repaired a few incisions/tears without using anesthetic. - MoonDragon Midwife

  • The surgical area is repaired with sutures that will be absorbed by the body. The skill of the practitioner or midwife doing the repair is important. All tissues need to be matched, aligned and repair done properly using sterile technique.

  • MoonDragon's Suturing Equipment & Supplies
    MoonDragon's Pre-suturing Preparation
    MoonDragon's Procedures: Administering Anesthesia
    MoonDragon's Suturing Information - Episiotomy Repair





    EPISIOTOMY EXPECTED OUTCOME

  • Expect complete healing without complications. Allow about 6 weeks for recovery from childbirth.


  • If you have had an episiotomy (or tear), you will have stitches in a very tender area and you will need some time to heal. Your stitches will disintegrate (absorbable sutures usually made from chromic catgut) during the first weeks after delivery and will not need to be removed by your practitioner. Some women feel little pain within a week or two, while other have discomfort for a month or more, particularly if they have a third or fourth degree laceration.





    EPISIOTOMY POTENTIAL COMPLICATIONS

  • Excessive bleeding.
  • Surgical-wound infection.
  • Inadvertent injury to sphincter or rectum.
  • May lead to increased risk of vaginal and/or rectal injury.
  • Incomplete healing usually caused by poor surgical repair.
  • Pain of perineum continues after healing.
  • Inability to resume sexual intercourse after healing. May be caused when the vaginal opening has been sutured too tight or too small for penile penetration.
  • Possible tearing risks along old scar tissue during later childbirth.
  • Incontinence of bowel from improper anal sphincter repair.





  • EPISIOTOMY POST PROCEDURE CARE

  • Bathe and shower as usual. You may wash the incision gently with mild unscented soap.

  • Take warm baths several times a day as long as you experience discomfort. A warm sitz bath may help relieve discomfort. Comfrey Leaf may be added to the sitz bath, making an infusion to help in healing. See Rules For Wound Care below for more information and recommendations.

  • Use ice packs made of gauze soaked in ice-cold Witch Hazel to ease discomfort during the 24 hours after delivery will ease the discomfort and prevent or reduce swelling.


  • RULES FOR WOUND CARE WITH OR WITHOUT SUTURES

    If a woman does not get sutures and has torn, she needs to follow the same rules that someone who has had sutures does. These rules are as follows:

  • Stay in bed with legs together as much as possible for 2 weeks.

  • Keep legs together at all times.

  • Sit very gently when urinating or having a bowel movement.

  • Kegel exercises - 150 daily.

  • Drink plenty of prune juice, drink lots of water and juices, and avoid constipating foods. Include fiber, such as bran, in the diet. Constipation is not a desired situation while the perineum is healing. I would describe the first bowel movement under the best of conditions as "passing a roll of barbed wire". Keep the stool as loose as possible to prevent straining.

  • Do not strain on the toilet. Not only is this painful, but it puts undesired pressure on the healing perineum.

  • Place an ice pack on the perineum for 1 hour to reduce swelling. Make sure you have a barrier between the ice pack and skin tissue. You do not want to freeze the tissue. A wash cloth, hand towel or thick layer of gauze will work. You can try soaking gauze pads with Witch Hazel and stick them in the freezer to the point of freezing (very cold and pliable but not frozen solid). Apply the cold Witch Hazel pads to the sore perineum.

  • Use Comfrey Infusion (Tea) pericare after urination (washing the perineal area with a comfrey tea and apply comfrey tea soaked 4x4 gauze pad compresses to the perineal area to soothe injury. Urine may cause a stinging sensation in sensitive perineal tissues. Pouring warm water over the perineum while urinating will help prevent stinging and helps to wash away the urine at the same time. Blot dry with gauze pads (do not flush, put in a trash barrel instead). Do not rub or wipe perineal area. This may open tissues that are repairing.

  • Apply herbal ointment (such as Comfrey Ointment, Aloe Vera Gel, or Calendula Ointment) to the area GENTLY. Warm comfrey infusion sitz baths can ease a sore bottom and promote healing. Drink Comfrey Leaf tea (to promote healing) - This can be added to Red Raspberry leaf tea to help with flavor. Red Raspberry leaf is a good woman's uterine tonic herb for pregnancy and postpartum. It helps to balance out hormonal shifts following childbirth.


  • Take the following supplements every day for at least two weeks:



  • RELATED LINKS

    MoonDragon's Pregnancy Information: Postpartum Care - Perineum
    MoonDragon's Health Therapy: Sitz Bath Therapy
    MoonDragon's Womens Health Information: Hemorrhoids
    MoonDragon's Womens Health Information: Incontinence, Urge
    MoonDragon's Womens Health Information: Incontinence, Stress



    RECOMMENDED HERBAL & SUPPLEMENT PRODUCTS

  • Aloe Vera Herbal Products
  • Calcium Supplement Products
  • Calendula Herbal Products
  • Comfrey Herbal Products
  • Fiber Complex Supplement Products
  • Prenatal Multivitamin & Mineral
  • Psyllium Fiber Herbal Products
  • Red Raspberry Herbal Products
  • Vitamin B-6 Supplement Products
  • Vitamin B-12 Supplement Products
  • Vitamin B-Complex Supplement Products
  • Vitamin E Supplement Products
  • Witch Hazel Herbal Products
  • Zinc Supplement Products





  • MEDICATION

  • You may use non-prescription drugs, such as acetaminophen or ibuprofen for minor pain.
  • Stool softener laxative (or lots of prune juice! A much safer and tastier remedy) to prevent constipation if needed.
  • Antibiotics, if required to fight infection.





  • ACTIVITY RECOMMENDATIONS & RESTRICTIONS

  • Follow your midwife's or health care provider's advice on resuming, or beginning, a postpartum exercise program.
  • Resume driving 10 days after the birth.
  • Resume sexual relations as directed by your midwife or health care provider or when a follow-up postpartum examination determines that healing is completed (usually 3 to 6 weeks).


  • SEXUAL ACTIVITY AFTER AN EPISIOTOMY

    Your perineum should be completely healed around four to six weeks after delivery, so if your caregiver gives the okay and you are up to it, you can try having sex then. You might feel some initial tenderness and tightness.

    Try having a glass of wine, taking a warm bath, and leaving plenty of time for foreplay. You might prefer to be on top so that you can control the degree of penetration, or you may find that lying on your side is most comfortable.

    Relaxing as much as possible and using a good water-soluble lubricant will help make sex more comfortable. This may be especially helpful if you are breastfeeding, because lactation lowers your estrogen levels, which reduces the amount of lubrication your vagina can produce. Many women continue to use a lubricant during sex until they stop nursing.

    MoonDragon's Pregnancy Information: Postpartum Care - Elimination





    DIET & NUTRITION

  • Eating a high fiber diet will help prevent constipation which is common after childbirth. Increase your fluid intake as you increase your fiber intake. Continue taking your Prenatal Multinutrient Supplements after your baby is born while you are breastfeeding your baby. The nutrients in your prenatal supplement will help in your healing process and recovery from an episiotomy and from childbirth in general.


  • MoonDragon's Pregnancy Information: Postpartum Care - Elimination
    MoonDragon's ObGyn Womens Health Information: Constipation
    MoonDragon's Nutrition Information: Fiber Diet
    MoonDragon's Nutrition Information: Nutrition Index





    NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER

  • Pain, swelling, redness, drainage or bleeding increases in the surgical area.
  • You develop signs of infections: general ill feeling and fever, headache, muscle aches, dizziness.
  • You experience nausea, vomiting, constipation or abdominal swelling.
  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
  • Pass uncontrolled urine through the vagina.
  • Pass gas (flatus) or stool from the vagina.


  • MoonDragon's Pregnancy Information: Episiotomies - What You Should Know

    POSTPARTUM LINKS

  • Postpartum Care: Index
  • Postpartum Care: Weight
  • Postpartum Care: Diet
  • Postpartum Care: Bowel Movements & Urination
  • Postpartum Care: Bathing
  • Postpartum Care: Breasts & Breastfeeding
  • Postpartum Care: Perineal Care
  • Postpartum Care: Vaginal Bleeding (Lochia) & Menstruation
  • Postpartum Care: Exercise & Back Care
  • Postpartum Care: Sexual Intercourse
  • Postpartum Care: Contraception
  • PostPartum Visit: Day One
  • PostPartum Visit: Day Three
  • PostPartum Visit: Day Seven
  • PostPartum Visit: 4 to 6 Week Visit
  • Baby Care & Concerns
  • Fatigue & Exhaustion
  • Postpartum Depression (The "Baby Blues")





  • QUALITY SUPPLIES & PRODUCTS


    WOUND (EPISIOTOMY / PERINEAL LACERATION) HEALING SUPPLEMENT PRODUCTS

  • Aloe Vera Herbal Products
  • Calcium Supplement Products
  • Calendula Herbal Products
  • Comfrey Herbal Products
  • Fiber Complex Supplement Products
  • Prenatal Multivitamin & Mineral
  • Psyllium Fiber Herbal Products

  • Red Raspberry Herbal Products
  • Vitamin B-6 Supplement Products
  • Vitamin B-12 Supplement Products
  • Vitamin B-Complex Supplement Products
  • Vitamin E Supplement Products
  • Witch Hazel Herbal Products
  • Zinc Supplement Products






  • MoonDragon's Womens Health Index

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    Health & Wellness Index





    AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES


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    Angelica Oil
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    Healing Baths For Colds
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    Herbal Cleansers
    Using Essential Oils


    AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES


    Almond, Sweet Oil
    Apricot Kernel Oil
    Argan Oil
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    Black Cumin Oil
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    HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS

  • MoonDragon's Nutrition Basics Index
  • MoonDragon's Nutrition Basics: Amino Acids Index
  • MoonDragon's Nutrition Basics: Antioxidants Index
  • MoonDragon's Nutrition Basics: Enzymes Information
  • MoonDragon's Nutrition Basics: Herbs Index
  • MoonDragon's Nutrition Basics: Homeopathics Index
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  • MoonDragon's Nutrition Basics: Minerals Index
  • MoonDragon's Nutrition Basics: Mineral Introduction
  • MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index
  • MoonDragon's Nutrition Basics: Dietary Supplements Introduction
  • MoonDragon's Nutrition Basics: Specialty Supplements
  • MoonDragon's Nutrition Basics: Vitamins Index
  • MoonDragon's Nutrition Basics: Vitamins Introduction


  • NUTRITION BASICS ARTICLES

  • MoonDragon's Nutrition Basics: 4 Basic Nutrients
  • MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients
  • MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute?
  • MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods
  • MoonDragon's Nutrition Basics: Foods That Destroy
  • MoonDragon's Nutrition Basics: Foods That Heal
  • MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals
  • MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods
  • MoonDragon's Nutrition Basics: Phytochemicals
  • MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce
  • MoonDragon's Nutrition Basics: Limit Your Use of Salt
  • MoonDragon's Nutrition Basics: Use Proper Cooking Utensils
  • MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water





  • RELATED MOONDRAGON HEALTH LINKS & INFORMATION

  • MoonDragon's Nutrition Information Index
  • MoonDragon's Nutritional Therapy Index
  • MoonDragon's Nutritional Analysis Index
  • MoonDragon's Nutritional Diet Index
  • MoonDragon's Nutritional Recipe Index
  • MoonDragon's Nutrition Therapy: Preparing Produce for Juicing
  • MoonDragon's Nutrition Information: Food Additives Index
  • MoonDragon's Nutrition Information: Food Safety Links
  • MoonDragon's Aromatherapy Index
  • MoonDragon's Aromatherapy Articles
  • MoonDragon's Aromatherapy For Back Pain
  • MoonDragon's Aromatherapy For Labor & Birth
  • MoonDragon's Aromatherapy Blending Chart
  • MoonDragon's Aromatherapy Essential Oil Details
  • MoonDragon's Aromatherapy Links
  • MoonDragon's Aromatherapy For Miscarriage
  • MoonDragon's Aromatherapy For Post Partum
  • MoonDragon's Aromatherapy For Childbearing
  • MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing
  • MoonDragon's Aromatherapy Chart of Essential Oils #1
  • MoonDragon's Aromatherapy Chart of Essential Oils #2
  • MoonDragon's Aromatherapy Tips
  • MoonDragon's Aromatherapy Uses
  • MoonDragon's Alternative Health Index
  • MoonDragon's Alternative Health Information Overview
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  • MoonDragon's Alternative Health: Touch & Movement Therapies Index
  • MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy
  • MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy
  • MoonDragon's Alternative Health: Therapeutic Massage
  • MoonDragon's Holistic Health Links Page 1
  • MoonDragon's Holistic Health Links Page 2
  • MoonDragon's Health & Wellness: Nutrition Basics Index
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  • MoonDragon's Health & Wellness: Massage Therapy
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  • MoonDragon's Health & Wellness: Pain Control Therapy
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