Will you need an episiotomy when you have a baby? Let's talk about this!

If you are preparing to give birth, one of the questions on your mind is definitely "Will I have to have an episiotomy ?". While this was common practice during the birth of our mothers and grandmothers, things are much different today. However, sometimes this may be necessary due to an emergency. So, let's talk about this in a clear and simple way.

Simply put, what is an episiotomy?

An episiotomy is a small surgical incision made by a doctor in the area between the vagina and the anus (medically called the `perineum`) during childbirth to enlarge the opening of the vagina to make it easier for the baby to come out. The main purpose of this is to increase the space available for the baby to come out.

In the past, this incision was performed on almost every mother who gave birth. But today, it is not done routinely. However, this is not entirely a thing of the past.

Then and Now: Why did this policy change?

Decades ago, episi OT omy was very common. And there were reasons for that.

At that time, many doctors used instruments like forceps to help with childbirth. So they needed extra space to use those instruments properly. Also, doctors back then thought that it was better to cut neatly than to let it tear naturally. There was also a belief that this cut would reduce long-term problems that could occur after childbirth, such as incontinence and pain during sex.

However, research has shown that this is not the case.

Research since the 1990s has shown that episiotomy does not provide as many benefits as previously thought.

According to some studies, about 85% of women experience some degree of natural tearing during childbirth. These tears (and episiotomy cuts) can range from minor to severe (doctors classify them as first, second, third, and fourth degree). In the most severe cases, the muscles of the rectum and its inner lining can be damaged , which can lead to difficulty controlling bowel movements.

If an episiotomy is performed, there is a risk that the incision may spread further than it would naturally tear and damage the rectal muscles.

So, in what cases is an episiotomy still performed today?

Nowadays, doctors rarely recommend an episiotomy as an option for a mother. However, it may be necessary in emergency and medically necessary situations, such as the following:

• If the baby experiences any discomfort (fetal distress): For example, if there is a sudden change in the baby's heart rate.
• If the baby is large: There is not enough space for the baby to come out.
• If delivery needs to be expedited: If delivery needs to be expedited for the safety of the mother or baby.

Also, research has shown that an episiotomy is not very useful in the emergency situation called ` Shoulder Dystocia` , where the baby's shoulder gets stuck in the birth canal. Because in that case, the obstruction is the mother's pelvic bones, not the soft tissues.

What to expect during and after an episiotomy?

During the process

An episiotomy is something that happens before you even realize it. The incision is made in a matter of seconds.

• If you're getting an epidural to reduce the pain, you won't feel anything.
• Even for a mother who gives birth naturally, this incision may not be felt separately from the pain of labor at that moment.

After the process

After your baby is born, your doctor will stitch the incision and repair it. You may experience some pain and swelling for a few days afterward. The following things can help:

• First 24 hours: Ice the area.
• Painkillers: Ask your doctor for a suitable painkiller for you.
• Cleaning: Use a squirt bottle with lukewarm water to clean the area.
• Sitz baths: Sitting in a basin of lukewarm water for a few minutes can greatly reduce pain and discomfort.

Will an episiotomy be performed for the next baby?

Probably not. Just because you had an episiotomy during your first birth doesn't mean you have to have one for your second. Your doctor may decide to let the tear happen naturally the second time.

Every pregnancy and birth is different. For example, if your first baby was large and you had to have an episiotomy, but your second baby is smaller, or if the baby is in a different position, you may not need an incision. The tear that occurs naturally may be smaller than a surgical incision.

However, if you have had a previous severe tear or episiotomy that has caused fecal incontinence, your doctor may recommend a C-section for your next delivery to prevent a severe tear from occurring again and causing long-term problems.

Can an episiotomy or tear be prevented?

There is no 100% guaranteed way to prevent an episiotomy or tear, but there are things you can do to help reduce the risk.

• Perineal massage: Some women use oil to massage the area between the vagina and anus during the last month of pregnancy. Although this has not been scientifically proven to be beneficial, it is not harmful.
• Slow, controlled delivery: This is the most important thing. When the baby's head comes out (crowning), instead of pushing hard all at once, use "little pushes." This gives the vaginal tissues time to gradually stretch. It is very important to follow the instructions given by your doctor or nurse exactly.

Talk openly with your doctor about any fears or doubts you have about giving birth. He or she will explain the most suitable and safest method for you.

Episiotomy, childbirth, having a baby, vaginal incision, perineal tear, natural tearing, pregnancy care