Episiotomies: An overview

If the thought of someone slicing into your perineum makes you shudder, take a deep breath because they are no longer done as a matter of routine. Also worth remembering, if you have to have one, is that it's only done to help you have a healthy baby - a very good reason indeed. Here midwife Sonya Murray gives an overview of what's involved.

• What is it and why is it performed?
• Can I choose whether to have one?
• Isn't it better to tear than have a cut?
• Will it hurt?
• Can I avoid an episiotomy?
• Stitches & bruising: Ways to help & heal
• When can I resume my sex life?
• The bottom line

An episiotomy is a cut in your perineum which is the area between your vagina and anus. It is performed to enlarge the birth outlet. Luckily the chances of this happening during birth is much less than it was a few years ago because numerous studies have concluded that episiotomies should not be done without good medical reason. Episiotomy may be needed when:

• Your baby is in distress
• Your baby's shoulder is stuck ( shoulder dystocia)
• The perineum is not stretching and thinning enough
• Your baby's head has crowned (it's visible) but is having difficulty making further progress
• For difficult forceps deliveries

Yes and no. You can write in your birth plan (this is where you write your birth wishes) that you would prefer not to have an episiotomy however there are some circumstances where your midwife may advise cutting your perineum to help your baby to be born. This may be if your perineum is not stretching enough to let your baby out or if your midwife thinks you may tear badly. It can also be done if your baby is distressed and the midwife would prefer your baby to be born soon.

It can be. Tears tend to heal better and research shows that tears are less painful for women than episiotomies. However, a tear can go as far as your anus (you may have heard of a third degree tear) and if this looks likely, it is better to have an episiotomy where the cut is made away from this area. Your midwife is the best judge during labour to decide if an episiotomy is necessary.

Will it hurt?

You will receive a local anaesthetic in the area prior to an episiotomy. Often the perineum is quite numb from stretching anyway but you are likely to feel some discomfort afterwards.

Good news, there are some things you can do to reduce your risk of needing an episiotomy:

• Perineal massage Midwives report that women who practice perineal massage from about week 36 of their pregnancy experience less stinging sensation during crowning and because of a more conditioned perineum are less likely to tear or have an episiotomy. An added value of perineal massage is that it familiarizes a woman with stretching sensations in this area so she will more easily relax these stretching muscles when stinging occurs just before the moment of birth.

  You can use any of the following: Pure vegetable oil, cocoa butter, olive oil, vitamin E oil or a special perineal massage oil.
  For more information about perineal massage click here

• Birthing your baby in an upright position This means that your body is essentially upright such as standing, squatting or on your knees. You are then able to work with gravity (as opposed to against it if you were lying down). It is now well accepted by midwives that upright positions help with birthing so ask for help to get into an ideal position.
• Avoiding extreme pushing Firstly, practice on the loo and consider not pushing. Use breathing which puts pressure downward (like when you push but without the breath holding). So take that 'bearing down' exercise with your breathing into labour. So not long breath holds but put pressure downwards with your muscles and your breath. Add this ontop of upright positioning and you have a winning formula!
• Stay relaxed and gently nudge your baby down allowing tissues to stretch By staying relaxed you will have "good hormones" as apposed to when you are stressed when you will have "fight or flight hormones". The good hormones or endorphins will help you with pain control and ensure you are further relaxed. Being active, enjoying a massage and being in good positions as discussed above will help you nudge your baby out (albeit with a bit of concentration and work it is very achievable).

1.It is important to practice your pelvic floor exercises - even if the area is numb, this will help the blood flow and aid healing

2. Keep your perineum clean and dry by using a bidet, or bottle of water to squirt on the area and regularly changing pads

3. Homeopathic remedies like arnica are good for bruising - check with your local homeopath or natural health shop

4. Ice packs can offer comfort because they will help reduce swelling. Make sure you cover the pack and only use it for 5 minutes at a time because the intense cold can hinder blood flow after a time.

5. Hire a valley cushion from the National Childbirth Trust which relieves pressure in this area and will help you to sit more comfortably!

6. Avoid constipation by keeping your fibre intake up and drinking plenty of water.

Your midwife will check any stitches to ensure the area is healing.Usually stitches dissolve on their own - this can take 2 -12 weeks depending on the make of stitching used. If they are causing problems (for example feel very tight) the midwife may remove them if your skin and muscles appear to have healed well.

When you feel ready! There is no rush and some women like to wait until their postnatal check which is carried out 6-10 weeks after your baby is born. You may find that using a lubricant like KY jelly will keep your more comfortable. Speak to your midwife or health visitor if you are concerned as they can give you individual advice.

Even the thought of an episiotomy is uncomfortable. Fewer are performed now than in the past few decades. Research is encouraging perineal massage in pregnancy from 36 weeks onwards and this is thought to reduce the chances of needing an episiotomy during labour - certainly worth considering.

About the author

Sonya Murray RGN, midwife, aquanatal coach and Hypno Birthing practitioner. In 2006 she set up Baby Gurus to offer contemporary antenatal courses in a luxury setting.

Where to next?

• Learning in luxury - find out about a new-style antenatal class
• Find out more about assisted deliveries
• Perineal massage - can it prevent tearing? Find out more here
• What happens if you have an unplanned home birth? Check our information
• Visit our main Labour and birth section
• Talk to other pregnant women on our Labour and birth discussion board
• Birth abroad: an English midwife gives her account of birth in a German ‘birth house’
  
• Thinking of having a homebirth? Talk to other mums-to-be about giving birth at home in our Homebirth discussion forum