Tears and episiotomies have become common during childbirth, leaving many women to wonder if they’ll need one during natural birth.
Before asking if you’ll need one, it’s important to know all the facts about what an episiotomy is and what it requires. The entrance to the vagina and the skin between the vagina and the anus called the perineum stretches during childbirth to allow the baby to come out. A tear can happen if the perineum and/or vagina aren’t stretching enough, at which point it can strain and tear. An episiotomy is a cut made by a doctor or midwife to enlarge the opening.
Types of tearing
- 1st-degree tear- This involves the back of the vagina and the skin of the perineum. These tears usually heal naturally and require no stitches.
- 2nd-degree tear- The back of the vagina and the skin, as well as the muscles of the perineum, are torn. This tear requires stitches.
- 3rd-degree tear- This tear extends from the back of the vagina, into the skin and perineum muscles and through the anal sphincter. This tear requires stitches.
- 4th-degree tear- This is similar to a 3rd-degree tear except it extends all the way to the rectum. This tear requires stitches and takes the longest time to heal.
In some instances, a tear occurs at the top of the vagina. These tears require little or no stitches and are known as peri-urethral lacerations.
Types of Episiotomies
- Midline: This is done straight from the vagina towards the anus. This tear is easy to repair but increases the risk of the tear extending into the anus.
- Mediolateral: This is done at an angle off the side of the anus. This tear offers the best protection from an extended tear reaching to the anus but is difficult to repair and takes a while to heal.
Do I need an episiotomy?
Routine episiotomy is not necessary or recommended during spontaneous vaginal birth. An episiotomy is only considered if:
- you are having a breech birth
- there is a need for an assisted birth, for example, the use of forceps
- your baby is in fetal distress
- you are having a long labor
- your baby is large
- you have some medical condition that requires labor to be sped up
Remember, the above are only reasons to consider an episiotomy. They’re not instances that require one!
What happens during an episiotomy?
The doctor or midwife will numb the area then make a cut. After the baby is born, the cut is stitched up.
Care and recovery
It may take up to a month for your tear to heal and the stitches to dissolve. You will continue to feel some moderate discomfort for some time after this but this should eventually completely disappear. An episiotomy can lead to scarring. You can care for yourself by doing the following:
- Bathe in warm water and sit on a valley cushion (inflatable cushion specially designed to make sitting more comfortable).
- Place an ice pack or ice cubes on the affected area to relieve pain.
- Urinating can be very painful so pee in the shower or pour a jug of warm water over yourself while you pee.
- Ask for a laxative to make passing stool easier until you heal.
- Pour warm water over your perineum after using the toilet to keep it clean.
- Try Kegel exercises. They enhance blood circulation and aid the healing process.
The most serious tear is the 4th-degree tear. It may lead to anal incontinence in rare cases. Speak to your doctor or midwife if you are having trouble.
Sex after an episiotomy
If you get a cut or a tear, you will no doubt be nervous about having a sex life again. Nine out of 10 women report that sex after a tear is painful but it improves over time as the tear heals.
If the pain is unbearable and does not seem to be subsiding contact your doctor.
Is there any way I can prevent tearing?
During the last weeks of pregnancy, it has been shown that massaging the perineum can reduce the likelihood of tearing.
Sit or lie down comfortably with your legs bent at the knees so you or a partner can reach the perineum.
Massage oil (vegetable-based) into the skin of the perineum.
Then place your fingers around 5cm (2 inches) inside your vagina and press downwards towards the anus; move to each side in a U-shaped stretching movement. This may give a tingling/burning sensation.
Hold the stretch for 30-60 seconds then release.
During the second stage of labor, your health care provider might apply warm compresses between your anus and vaginal opening. This helps to soften tissue reducing the likelihood of a tear or an episiotomy. While the thought of an episiotomy may sound frightening, just remember that it is not uncommon and your doctor will only do one when it is necessary.
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first published at www.nct.org.uk