Although Episiotomy is not widely practiced, it is still an essential procedure that aids successful vaginal delivery.

What Does Episiotomy Mean

An episiotomy is a surgical slit in the area of the perineum during childbirth. The perineum is a diamond-shaped muscular area between the vagina and anus.

It makes the vaginal opening larger to deliver the baby successfully during an emergency. The Episiotomy is done during the second stage of labor, and it is also known as Perineotomy.

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Types Of Episiotomy

There are four types of Episiotomy:

1. Median or midline

2. Mediolateral

3. Lateral

4. J Shaped

Median or Midline and Mediolateral types of Episiotomy are more commonly practiced. 

Median Episiotomy is more often practiced in the USA and Canada. However, mediolateral Episiotomy is preferred in the rest of the world, like India, etc.

Median Episiotomy

The cut is made downwards from the vaginal fourchette towards the anus. It runs for about 2.5 cm in length.

Mediolateral Episiotomy

The cut is made downwards and outwards from the vaginal fourchette. The outward direction of the incision is either to the right or left. It is 2.5 cm long and directed diagonally in line, which runs on a midpoint between the anus and ischial tuberosity.

The median and mediolateral Episiotomy have their own advantages and disadvantages.

Episiotomy Rates

The rates of Episiotomy are higher in primipara, and it is not practiced in uncomplicated deliveries.

The study states that more than 52% of the women with vaginal deliveries had Episiotomy to deliver their baby successfully.

Around 93% of the women with first-time pregnancies had Episiotomy, and 30% in pregnant women with multiple pregnancies.

Causes Of Episiotomy

The natural stretching of the tissues will help reduce the need for Episiotomy in most women. 

The Episiotomy is advised by your health care provider in the following situations:

1. Large baby
2. Prolonged labor
3. Forceps delivery
4. Vacuum delivery
5. Breech presentation
6. Shoulder dystocia – where baby’s shoulders are trapped after the head is delivered
7. History of pelvic surgery
8. Delivery of twins
9. Fetal distress
10. Previous history of a vaginal tear
11. Mother exhausted from pushing baby
12. Preterm baby

Complications Of Episiotomy

There is a possibility of complications in few women who have undergone Episiotomy.

Immediate Complications Of Episiotomy

1. Deep cut and tear in the perineal region
2. Tearing of rectal tissues
3. Bleeding
4. Blood loss
5. Swelling around the suture site
6. Infection of the suture site
7. Loss of anal sphincter control
8. Dyspareunia – Difficulty or pain during sexual intercourse
9. Post Partum Fever

Longterm Complications Of Episiotomy

1. Prolapse
2. Urinary incontinence
3. Repeated infections
4. Sexual Dysfunction
5. Anorectal impairment

How Long Does It Take For An Episiotomy To Heal

The episiotomy suture usually heals by the end of 3rd week, and in some, it may heal by four to six weeks. 

Generally, there is pain and discomfort during the first week, and it may gradually decrease. After that, each person recovers at a different rate. 

How To Treat Episiotomy Pain

These techniques will bring down the soreness after the delivery of your baby.

1. Ice Packs

Place the ice packs after the delivery to provide soothing and relief from pain. In addition, the cold temperature will help reduce the swelling and pain.

2. Pain Medications

Pain medications are started right after the delivery as the pain will reappear when the anesthetic effect weans. Your health care provider will prescribe you enough medicines to take care of your pain during the first week.

If the pain persists after the first week, then consult your healthcare provider. He will perform an examination and advice accordingly based on the state of your stitches.

3. Warm Bath

Avoid taking a bath until 24 hours after childbirth. After that, a bath in a bathtub or hot shower will relieve you from pain. Clean the bathtub properly before each bath. 

You can use a hand shower with a mild speed of warm water outflow and direct it on the wound. It will work like magic. Do it once or twice a day.

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How To Treat Episiotomy Wound

Wound care aims to prevent the infection of the site and speedy recovery of the wound site. 

1. Sitz Bath

Soaking the perineum in the warm tub with Epsom salt is added to the tub. The tub will soak the vulvar region and will reduce swellings, pain, infection. 

Sitz bath helps to heal the area at a faster rate. 

There are many varieties of sitz baths available commercially.

2. Exposure To Fresh Air

After a hot water bath, remove your underwear and lie on the bed with a towel placed on it. Sleep on the bed for 10 to 15 minutes to allow the area to dry. Do this once or twice a day for better results.

Exposure to the fresh air will reduce the pain and help the stitches to heal faster.

3. Warm Tea Bags

Soak the black tea bags in warm water and place them on the wound area. The astringent properties of the tea will help shrink and constrict the wound, thus aids the faster recovery.

4. Frozen Perineal Pads

You can use the frozen perineal pads to relieve the swelling in the suture area.

There are many frozen perineal pads available in the market. You can consult your doctor before using them. Meanwhile, I have shared the list of the best available frozen perineal pads in the market.

5. Drink Plenty Of Water

Drinking plenty of water after the delivery will regulate your bowel movements. Avoiding straining while passing stools and constipation will help heal the suture area faster.

6. Stool Softeners

Let your health care provider know about straining while passing stools even after drinking sufficient water.

The doctor will prescribe you mild laxatives or stool softeners to aid easy bowel movement. In addition, prevention of straining will relieve you from pain and discomfort.

Following a diet with high fiber food will act as a natural laxative to aid the easy passage of stools.

7. Change Pads Often

Changing sanitary pads often will keep the area dry rather somewhat moist due to the prolonged use of the same pad.

You know by now that keeping the area dry for a long time will help the faster healing of the wound.

8. Clean The Area After You Pee And Passing Stools

Use a generous amount of water to clean the wound area after peeing and passing stools. 

Maintaining the general hygiene of the suture area will prevent infection, and the site will heal faster.

The main goal is to keep the area clean as possible.

Would Like To Conclude 

While you are in the progression of labor, your healthcare provider will assess you and advise you when Episiotomy is needed.

Health care providers will explain the risk and advantages of Episiotomy and the risk if you do not have one.

Every procedure has its advantages and disadvantages. Episiotomy is one such procedure that is routinely practiced to have a healthy mother and baby. 

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