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Episiotomy

Definition - What does Episiotomy mean?

An episiotomy is a surgical cut made in the perineum — the diamond-shaped area between the vagina and the anus — during vaginal delivery. Its goal is to widen the vaginal outlet prior to childbirth so that the baby can be born without much difficulty. The procedure also aims to prevent tearing of the women's soft tissues. An episiotomy used to be a normal part of childbirth in the past, but its routine use has been questioned since the last few years. Experts now suggest that the idea of preventing vaginal tears via an episiotomy may actually come at the expense of more complications, including infertility.

FertilitySmarts explains Episiotomy

Vaginal tears are common during a difficult childbirth and may occur as the woman bears down while the baby makes its way out into the world. For successful vaginal delivery, the vaginal tissues should stretch in a natural way, so the tissues don’t tear while the baby’s head passes through. Until now, this procedure was supposedly done to prevent such tears. It was also believed that an episiotomy cut would heal faster than natural or spontaneous tears. However, this is not the case now. In fact, selective episiotomies are favored over the routine ones only in selected conditions, such as:

  • When the baby is in distress as detected by an increase or slowing down of its heart rate (cuts off the oxygen supply to the baby, warranting an episiotomy to accelerate childbirth and save the baby’s life).
  • When instruments (like forceps or ventouse suction) need to be passed through the vagina in certain conditions that are likely to tear the woman’s soft tissues or that endanger the baby’s life such as due to:
    • A breech baby
    • A large baby
    • Extended labor of several hours with the woman constantly trying and pushing — exerts pressure on the soft tissues
    • A serious health condition in the mother that mandates faster delivery to minimize any further risks

There are two most common types of episiotomies:

  • Midline – a cut is made in the vaginal opening and extended straight down towards the anus.
  • Mid-lateral – a cut is made in the mid of the vaginal outlet and extended toward the hips at a 45-degree angle. In the UK, this is more common than the midline.

The complications that can occur following an episiotomy include:

  • Pain and swelling at the incision site. An ice pack, shallow water baths (sitz baths) or local numbing creams or sprays may help minimize swelling and pain as well as speed healing.
  • Bruising
  • Bleeding
  • Infection
  • Extension of the episiotomy cut into the rectal tissues and anal muscles that control the release of stool
  • Delayed healing
  • Painful scarring that causes the vaginal entrance to tighten too much, leading to pain during intercourse and eventual sexual dysfunction
  • Difficulty controlling the urge to pee, causing involuntary loss of urine (because of damage to the pee-hole)
  • A need for repeated episiotomies and further enhanced risks because of the weakening of scar tissue from the previous episiotomy that hinders future safe deliveries

For these reasons, today an episiotomy is only performed if deemed necessary. A midline episiotomy carries a higher risk of damage to the anal opening. However, as suggested in medical literature, it has a few benefits over the mid-lateral approach — such as better future sexual function and better healing with a less distorted scar.

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