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While you may not know exactly what it even is, you probably wince at the very thought of it: we're talking about the episiotomy, a surgical cut to the perineum (the muscular area between the vagina and the anus) made during pushing to enlarge the vaginal opening for birth.
Why are episiotomies performed?
Why do some people oppose episiotomies?
What can you do?
If your health care provider doesn't perform an episiotomy, will you tear anyway?
Recovery
WHY ARE EPISIOTOMIES PERFORMED?
Some health care providers (usually obgyn physicians) who perform episiotomies feel the procedure speeds deliveries by shortening the pushing stage (thus reducing the chance that baby will suffer from oxygen deprivation) and can help prevent vaginal tearing during delivery. Many argue that the careful, clean incision heals more easily and faster, and with less discomfort, than a ragged natural tear.
WHY DO SOME PEOPLE OPPOSE EPISIOTOMIES?
Many midwives and other health care providers object to episiotomies, citing compelling evidence that the procedure may not be necessary -- or even effective -- and certainly should not be routine. Recent studies claim that episiotomies can lead to more serious lacerations (the very thing they are supposed to prevent) than those sustained by women who weren't surgically cut, and that the recovery for an episiotomy can be as long or longer than that of an equivalent natural tear. Some claim episiotomies lead to a loss of sexual pleasure and incontinence. Possible episiotomy complications include rectal injury and sphincter muscle damage, and, as with any surgical procedure, episiotomies carry risk of infection, blood loss, and more.
WHAT CAN YOU DO?
Inform yourself and discuss your fears and concerns openly with your midwife or health care provider. Find out her or his thoughts on the procedure and what her or his episiotomy rate is, and discuss how you'd ideally like your particular situation to be handled.
Keep in mind that there are, of course, legitimate reasons for performing an episiotomy (such as when baby shows signs of distress or maternal indications warrant the procedure, such as a forceps delivery or vacuum extraction). The size of your baby, your baby's heart rate, your condition, and more can play a part in your health care provider's (and your) decision at the time of delivery. If you have made your wishes known and you trust your midwife or health care provider, you can be confident that (s)he will do what's best and most appropriate for you and your baby.
If you do have an episiotomy, rest assured that it can be performed relatively painlessly when you are pushing, because the extreme stretching helps to numb the perineum. Anesthetic can also minimize any pain you may feel.
IF YOUR HEALTH CARE PROVIDER DOESN'T PERFORM AN EPISIOTOMY WILL YOU TEAR ANYWAY?
You may or you may not. You can, however, lessen your risk of laceration by practicing perineal massage. Plus, the more conditioned your perineum, the less likely you are to need an episiotomy. Many midwives report that women who do perineal massage daily after 36 weeks gestation experience less stinging during crowning and also less tearing. Ask your midwife or health care provider for specific instruction and guidance.
RECOVERY
If you do have an episiotomy, or if you tear naturally, you will likely be sore and swollen for a while. But there's plenty you can do to lessen your discomfort and help the healing process:
- Sit carefully and preferably on a "donut:" a plastic or foam, air-filled, empty-centered disc that alleviates pressure on your bottom (drug stores have them).
- Use crushed ice or a package of frozen peas or corn wrapped in a clean cloth to make cold packs that will contour to your body and help keep swelling down and numb the pain. Your drug store may have special cold-pack maxi pads for this purpose.
- Take pain medication as needed (of course discuss the appropriate pain medication with your midwife, especially if you are nursing).
- Wash regularly with a warmed squirt bottle. Don't wipe. Gently pat yourself dry.
- Keep your stitches clean and dry (they should disappear on their own within a few weeks).
- When you're able, walk around and do your Kegel exercises to stimulate circulation and speed tissue healing.
- After 24 hours, take a soothing sitz bath: Sit in a tub of clean, warm water a few inches deep (just enough to cover your bottom). You can obtain a device that covers the toilet to serve the same purpose from your local drug store or home health care supply store. If you want, you can make a warm comfrey tea leaf decoction (strong tea) and use it in your sitz bath to soak your bottom. It will help with healing and soothing your repair.
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