Know your episiotomy

by Navya Singh


A woman has been blessed with the power to give birth to a new life. Pushing a human out of your uterus isn’t an easy task at all! In order to make others comprehend the pain of labour, it is often said that it is actually equal to twenty bones getting fractured in your body at the same time. Scary, isn’t it?


The period of labour and delivery isn’t the same for every woman. It differs according to their health, current condition and if there are any added complications, then the case takes a completely different face. In order to ensure that a woman has a dignified labour and delivery period, it is important for them to be made aware of possible situations at the time of child birth beforehand.

Dissemination of such information falls under the ambit of antenatal care (ANC) and it is a must for every pregnant couple. A shiver runs up one’s spine even at the thought of labour pain – is a thought everyone would surely agree to! We all must have heard of a few different types of deliveries like caesarean, vacuum extraction etc. One of these is episiotomy. What is episiotomy? How it is done? When it is used? What are the complications related to it? What are its advantages? Let’s have a detailed look at the concept of episiotomy.


To begin with, let’s have a look at the definition of episiotomy. Episiotomy is defined as a surgical procedure for widening the outlet of the birth canal to facilitate delivery of the baby and to avoid a jagged rip of the area between the anus and the vulva (perineum). The vulva is the external part of the female genitalia. It protects a woman’s sexual organs, urinary opening, vestibule and vagina and is the centre of much of a woman’s sexual response.


During an episiotomy, an incision is made between the vagina and the rectum. The usual cut goes straight down and does not involve the muscles around the rectum or the rectum itself. There are two types of incisions: the midline, made directly back toward the anus, and the medio-lateral, which slants away from the anus. For women who didn’t opt for an epidural during labour, a local anaesthetic might be used.


It is important to not confuse episiotomy with caesarean or C-section delivery. A caesarean section is a surgical procedure performed if a vaginal delivery is not possible. During this procedure, the baby is delivered through surgical incisions made in the abdomen and the uterus. It may be planned or unplanned and take place during labour if certain complications arise. Whereas in the case of episiotomy, the incision facilitates vaginal delivery by enlarging the vaginal opening to allow the baby’s head to pass through more easily and to prevent tearing of the mother’s skin. Most women will not need one and is, therefore, reserved for special circumstances only.


For years episiotomy has been thought to help prevent extensive vaginal tears during childbirth and help heal better than a natural tear. It was also thought to help preserve the muscular and connective tissue support the pelvic floor. But now, the outlook towards episiotomy has changed. Even though now, routine episiotomies are not recommended, there might still be a few cases where it becomes a necessity for the baby to be delivered quickly. These include cases like when baby’s shoulder is stuck behind mother’s pelvic bone, abnormal heart rate pattern of the baby during delivery or if there is a need for an operative vaginal delivery.


According to a research conducted to evaluate the pattern of episiotomy use and its immediate complications among women delivering at tertiary level public hospitals in India, it was found that among 1,20,243 vaginal deliveries, episiotomy was performed in 63.4 per cent cases. In fact, it is one of the most commonly employed procedures for women delivering in tertiary level public hospitals in India with an overall episiotomy rate of about 70 per cent.

Now, after going through the article above the question of whether one should go for an episiotomy or not, must have definitely popped in your mind! In order to make the correct decision, it is important to have a look at the pros and the cons of this procedure.

Talking about the positives, episiotomy can decrease the amount of pushing the mother has to do during delivery. It also helps to decrease damage caused to the vaginal tissues.


Episiotomy is often recommended by the doctors as according to them a surgical incision is easier to repair than an extensive tear and the outcomes are more favourable and less complicated. It is possible for complications to occur in case of surgical procedure like episiotomy. A few risks involved in episiotomy are bleeding, swelling, defects in wound closure, localized pain and pain during sexual intercourse.

Another important question which comes up related to episiotomy is its healing procedure and time. After episiotomy is done, it is repaired by suturing or sewing the wound together. The repair process is pretty simple. Generally, the healing time for an episiotomy is around four to six weeks depending on the size of the incision and the type of suture material used to close the wound.

Delivery period is the most crucial and sensitive stage of pregnancy. It is the right of every mother to be informed about it and she should be mentally prepared to face any situation. Being informed is the key to an enlightened motherhood!

Sources

https://www.medicinenet.com/episiotomy/article.htm#what_is_the_healing_time_for_an_episiotomy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928554/

https://www.stanfordchildrens.org/en/topic/default?id=episiotomy-92-P07775

https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282

https://my.clevelandclinic.org/health/articles/9675-pregnancy-types-of-delivery

https://www.nva.org/what-is-vulvodynia/vulvar-anatomy/

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