Vaginal Stitching After Delivery - Is Episiotomy Necessary or Imposed Upon A Woman?

Vaginal Stitching After Delivery - Is Episiotomy Necessary or Imposed Upon A Woman?

Is the doctor going to cut me and where? This was not in my childbirth plan? These are some of the questions that trouble many pregnant women near the time of delivery. Surgical incision may or may not be in your plan but there are circumstances that could prompt your doctor to perform Episiotomy. Let’s know all about it along with its side effects and benefits.

Episiotomy

An episiotomy is a surgical procedure in which a cut is made in the perineum (the area between the anus and the vulva) during labor and delivery. The procedure is performed after the doctor gives the woman local anesthesia. The objective behind this surgical incision is to enlarge the vaginal opening in order to deliver the baby safely.

Is episiotomy a common practice?

In earlier times, this procedure was performed to prevent severe vaginal tearing during the childbirth. People also believe that a woman who undergoes episiotomy have better chances of recovery as compared to natural tearing. However, recent researches show just the opposite part of the picture. According to these findings, episiotomy may create more problems instead of preventing them.

It can raise the chances of getting infection and other such problems. Moreover, recovery also takes longer time and uncomfortable for many. These are some of the reasons why episiotomy is now conducted in certain cases only. However, in countries like India, it is performed on a routine basis and that too without informing the woman.

The statistics around the world also varies wildly. According to a 2010 report, 73 percent episiotomies were conducted in Portugal, followed by 43 percent in Spain, 27-28 percent in France-Germany, 19 percent in England and 5 and 7 percent in Sweden and Denmark respectively. The rate of US stood at 14 percent but the country is showing downward trend.

Reasons why episiotomy is performed?

As mentioned, there might be certain circumstances which can prompt the doctor to take quick decisions during childbirth. And for episiotomy, there are a few reasons which may lead to this decision:

Speeding prolonged labor

In cases where woman seems to be exhausted during prolonged labor or the child is experiencing distress, performing an episiotomy may accelerate delivery process. The doctors then makes extra room so that baby’s head can pass through easily, shortening the time of delivery.

Assist in vaginal delivery

Episiotomy may also prevent the need of delivering the child via forceps and vacuum extraction. The procedure reduces the force to the baby’s head, hence making the delivery process via forceps or vacuum easier preventing excessive tearing.

Delivering large baby

Sometimes woman especially who are carrying large babies may face a problem known as shoulder dystocia. In this complication, the shoulders of the baby are entrapped within the birth canal. An episiotomy creates more space in the area so that baby’s shoulder can pass through easily.

Abnormal birthing position

Normally, near the time of delivery, the baby comes in a position in which head remains at the bottom so that it can pass through easily. But in certain cases such a breech position or occiput anterior presentation, the baby remain in abnormal position. This can create problems in delivering the child safely. An episiotomy makes extra room in the vaginal area so that doctor can maneuver the child in the correct position and deliver it safely.

History of pelvic surgery

Vaginal deliveries in certain cases can create long term complications such as relaxation of the walls of vagina. This may result the cervix, bladder, rectum or uterus swell through the vaginal wall. This may result in women choosing the reconstructive surgery to fix the problems related to the vaginal wall. If they are going for this surgery, they should not go for another vaginal delivery as the repairs might be damaged, resulting in injury.

If still the woman insists on vaginal delivery, the use of episiotomy may ease the delivery process and avoid further damage to the repaired areas of the pelvis.

Twin delivery

Though twin deliveries through vagina are not common, applying episiotomy creates additional room to safely deliver the second child.

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Types of episiotomy and their pros and cons

There are basically two common forms of episiotomy. These include:

Midline episiotomy

In this type of episiotomy, the incision is performed in the center of the vaginal opening, towards the anus.

Pros – The midline episiotomy is less painful and there are less chances of long term tenderness. The procedure also facilitates easy repair and healing as well as less blood loss.

Cons – The major drawback of this procedure is the increased risk of tearing that may stretch up to the anal muscles. The injury can lead to long-term complications including fecal incontinence or the incapability of controlling or holding stools.

Mediolateral episiotomy

In this form of episiotomy, the cut is performed in the middle of the vaginal opening and extends all the way to the bumps at a 45-degree angle.

Pros – The most primary benefit of mediolateral episiotomy is that it prevents the risk of anal muscle tearing to a large extent.

Cons – There are many drawbacks of this form of episiotomy including:

  • Increased loss of blood
  • Difficulty in repairing
  • Induces severe pain
  • Long-term discomfort especially when resuming sex

Degrees of episiotomies

This surgical procedure is also classified on the basis of degree or the severity of the tear. These include:

First degree – Small tear which only covers the vaginal lining excluding the underlying tissues

Second degree – Also the most common, the tearing extends across the vaginal lining along with the underlying vaginal tissue, excluding rectal lining.

Third degree – Includes the vaginal lining, vaginal tissue as well as portion of rectal lining.

Fourth degree – The most severe form that covers vaginal lining, vaginal tissues, anal sphincter, and also the rectal lining.

Recovering from episiotomy

After the delivery, the doctor usually repairs the episiotomy within an hour. A little bleeding can happen at first but once the wound are sutured (stitched using thread), the bleeding should stop. And you don’t have to revisit the doctor for removing the sutures as they get dissolved within a month.

After effects

The doctor will recommend you to avoid certain activities for quick recovery. Every woman after vaginal delivery feels some level of pain in the perineum which can be worse if episiotomy is performed. So it’s not like that woman who don’t undergo episiotomy do not experience pain.

It’s normal to experience pain for 2-3 weeks after the procedure and women who have undergone 3rd and 4th degree of episiotomies would be feeling more discomfort and that too for long. The pain would be more severe while sitting and walking or any other movements. Urinating may also cause sharp stinging pain on the site.

Pain reduction

The nurse at the hospital would be checking the cut at least once every day to make sure there is no inflammation or infection on the site. She will also advise you to take precautions regarding postpartum perineum hygiene. Besides, for quick recovery the doctor would advise you following things:

  1. Using cold compression on the site
  2. Pain medications, stool softener and medicated pads
  3. Sitz bathing or sitting in a warm bath tub
  4. Using squirt bottle to clean yourself after toilet instead of using toilet paper

You must consult your doctor well in advance during the pregnancy phase itself as to how you can avoid episiotomy. The doctor may advise you some pelvic exercises, prenatal massage and warm compresses. Apart from this, you must call up your doctor if you experience constant pain, high fever, foul smell on the site, bleeding or unusual discharge from the area.

Sources

1. Perinatal Health Report. read more
2. Episiotomy and perineal tears. read more
3. Variation in and Factors Associated With Use of Episiotomy. 
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