This word suddenly becomes familiar when you are pregnant. Pregnant women here this word from their friends and have a lot of worries and queries.
An episiotomy is a cut that is given to you when the baby is ready to come out of the vaginal opening. It is given on the right or left side in the area between the vagina and the anus.
The doctor will give a local anaesthetic and then give the cut once the area is numb. In case you already have an epidural then there is no need of a local anaesthetic.
Once the placenta delivers then the doctor will suture the cut in layers with a suture material that does not need to be removed. i.e. the thread will dissolve on its own.
Most patients will need an episiotomy.
Common situations are as follows: –
First time delivery, big baby, prolonged labour, if you need ventouse of forceps to deliver the baby, in case the heartbeat of the baby is slowing down and various such situations.
It is safer to allow the doctor to do an episiotomy than to try delivery without the cut especially if the perineum is not stretched. If the perineum is not well stretched, then the muscles may tear leading to a tear through important structures like the anal sphincter and that will not only be difficult to repair but also affect function in the future.
In case there is a tear then that is repaired but it will depend on the extent of the tear. If only the muscle is torn, then it is simple. In case there is a tear through the anal sphincter or the rectal mucosa then that needs special attention and may have to be done in the operation theatre under anaesthesia. Further it will also need special care in the post-operative period.
The episiotomy is safe and once stitched and healed, will not have any long term implications. In some cases, there may be swelling, excess bleeding, infection and delayed healing. This may happen in anaemia, diabetics, instrumental delivery, and where vaginal manipulation may have been done eg manual removal of placenta.
After the delivery you must look after the episiotomy. You must keep the area clean and dry. You can apply a simple anti-septic cream in the area. Hot or cold fomentation and sitz bath can help reduce the pain and the swelling in the first few days.
You must avoid sex till the stitches have healed and ideally till the bleeding has stopped. It is advisable to avoid tampons in the post delivery period.
After delivery, the doctor will check the wound in your post-delivery visit. You must report to the doctor in case you have foul smelling discharge, pain, bleeding and if you think the stitches have broken down and the wound is gaping.
Episiotomy is safe, helps to deliver the baby and in most cases, heals well.
Dr Sangeeta Agrawal is experienced in the management of episiotomy. Feel free to have a discussion on the same when you register for delivery with her.