What is an episiotomy? Are you afraid of the incision made during childbirth?

As an expectant mother, you may have a number of questions and fears. It's normal to feel a little scared, especially when you hear stories like "cutting" and "stitching" during childbirth. Many people are afraid of this, but once you know exactly what it is, when it's done, and how to take care of it afterward, your fears will largely disappear. So today, let's talk about this thing called an episiotomy.

What exactly is an episiotomy?

Simply put, an episiotomy is a small surgical cut that your doctor makes in the area between the opening of your vagina and your anus (this area is medically called the perineum) to make it easier for your baby to come out. This cut makes the opening of your vagina a little bigger, making it easier for your baby to come out.

But this is not something that happens to everyone. Sometimes, without any incision, the perineum area can tear a little when the baby comes out. We call this a natural tear `(Perineal tear)` or `(laceration)`.

So, when is an episiotomy necessary?

Now, although this incision is not done often, sometimes it is necessary for the safety of you and your baby. The doctor will only make such a decision if he or she feels it is the safest option for you and your baby.

Here are some such cases:

• If the baby is in distress: In an emergency, such as when the baby's heart rate drops, you need to get the baby out as quickly as possible. This incision can be made to make the process easier.
• If you are very tired: If you are very tired after pushing for hours and don't have the strength to push any more, you can do this to help the baby come out.
• If you need to use forceps or vacuum devices: Sometimes these devices need to be used to remove the baby. If there is not enough room in the vagina to insert the devices, this incision is needed to create space.
• If the baby is in a different position: if the baby is breech or if the baby's shoulders are stuck (shoulder dystocia), this incision may be needed to make a larger opening for the baby to come out.
• If the baby is overweight (large baby): If the baby is larger than normal, there may not be enough room to come out.
• If you can't control your thrusts: Sometimes, pushing too hard without control can cause severe damage to the perineum. In such cases, the doctor may decide to make a small incision to control the damage.

Why is it better to tear it off on its own than to have a cut?

In the past, doctors thought that by making an incision, it would heal properly and prevent severe tearing. There was also a belief that it would reduce later complications such as urinary incontinence.

But new research has found that when an episiotomy is performed, the incision is more likely to tear further than expected . Also, a natural tear usually heals with less damage. That's why doctors are now trying to let the process happen as naturally as possible.

How does this incision process happen?

This is done during the second stage of labor, which is when the baby's head begins to emerge from the vagina (crowning).

1. Painkillers: First, you will be given painkillers to numb the pain. If you have already had an epidural, you will not need any additional painkillers because your lower back is already numb. Otherwise, the doctor will inject a small amount of local anesthetic into the perineum to numb it.

2. Making the incision: As soon as the baby's head presses against the perineum, the doctor makes the incision using special episiotomy scissors.

3. Removal of the baby and placenta: After the incision, the baby comes out, and then the placenta is removed.

4. Stitches: Finally, the doctor will use a type of suture that dissolves automatically to close the incision. At the same time, he will check the size of the incision and whether there are any other complications.

What are the types of cuts?

There are two main types of cuts.

What are the 'degrees' of a cut or tear?

Whether it's a natural tear or an episiotomy cut, it's graded from 1 to 4 depending on its severity.

• First-degree: A small tear that only affects the thin layer of skin on top of the vagina.
• Second-degree: A tear that extends into the tissue beneath the skin. Most episiotomy cuts fall into this category.
• Third-degree: A tear that extends through the vaginal tissue and into the anal sphincter.
• Fourth-degree: This is the most serious level. In this case, the tear extends through the rectal muscle and into the rectal wall.

How painful is an episiotomy?

However, after the numbness wears off, it is normal to feel pain at the site of the stitches for a few days, and to feel discomfort when walking or sitting.

What are the risks and complications of an episiotomy?

As with any surgery, there are some risks involved. But remember, some of these risks can occur even with a natural tear.

• Bleeding
• Infection of the suture wound
• Pain during sexual intercourse after healing (dyspareunia)
• Damage to the muscles of the rectum
• Leaving a scar
• Difficulty controlling urine
• Taking longer to heal

Things you can do at home to help stitches heal faster

It's normal to have some pain and discomfort for a few weeks after your stitches are removed. There are some simple things you can do at home to help reduce this discomfort and speed up your recovery.

• Apply an ice pack: To reduce swelling and pain, apply a few ice cubes wrapped in a clean cloth to the area where the stitches were placed for about 10-15 minutes. Do this several times a day.
• Take a sitz bath: This is very helpful. Fill a large basin with warm water and sit in it for about 15-20 minutes. This will reduce pain, improve blood circulation, and help the wound heal faster. It is best to do this two or three times a day.
• Use a peri bottle: The hospital will give you one of these. Or you can use a clean water bottle. After using the toilet, fill the bottle with warm water and gently rinse the area where the stitches are. This will keep the area clean and reduce the burning sensation when you urinate.
• Painkillers: Take a painkiller, such as paracetamol, as prescribed by your doctor.
• Sit on a donut pillow: Sitting on a donut pillow can cause pain as the stitches rub against it. Sitting on a cushion with a hole in the middle will reduce the pressure on the area where the stitches are.
• Stay clean: Always change your sanitary pads regularly and keep the area dry and clean.

When can I have sex again?

The wound usually heals in about 6 weeks. However, after your 6-week postpartum visit, you should consult your doctor and have sex again only after he or she gives you permission. It is normal to feel some pain or discomfort during the first few months. Using a water-based lubricant can help reduce this discomfort.

If you have these symptoms, see a doctor immediately.

If you have had an episiotomy and have any of the symptoms below, you should see your doctor immediately .

Episiotomy, episiotomy, having a baby, childbirth, suturing, perineal tear, women's health, pregnancy