At some point during your pregnancy, when you're reading the books or going to your antenatal classes, you'll come across the term 'episiotomy' and it'll probably make you cross your legs when you find out what it means.
But for some women, it really can be the better option during labour.
What is an episiotomy?
An episiotomy is a procedure that might be performed by a doctor or midwife during labour in order to ease or speed along the birth of your baby.
The procedure involves making a cut in the perineum (the space between the bottom of the vagina and the anus). It creates more space for your baby to emerge.
No-one goes into labour wanting to have an episiotomy but about one in seven women who give birth need to have one. Sometimes they are just necessary, and a decision will be made at the time – and the reasons explained to you.
Why might I need to have one?
There are two major reasons why your midwife might advise you that you need to have an episiotomy.
If your baby begins to suffer from foetal distress (which will be made apparent by their heart rate becoming very fast, or slowing right down), it could be because they are not receiving enough oxygen. So it will become necessary for your baby to be born quickly, to reduce the chances of any birth defects or still birth. That sounds frightening, but an episiotomy could vastly speed up the process of bringing your baby safely into the world and into your arms. If your baby's head has not entered the birth canal, then you might have the option of a caesarean section – but if your baby is on its way down, then an episiotomy will be necessary.
Another reason why an episiotomy might be required is if you need some assistance with giving birth, perhaps because your baby is breech, seems to have become stuck, or because you yourself are just too exhausted to push any more.
Having an episiotomy makes more room for your midwife or doctor to use instruments, such as forceps or ventouse suction.
How is an episiotomy performed?
Firstly, a local anaesthetic will be used to completely numb the area around the vagina, so you won't feel any pain. If you have already had an epidural, the anaesthetic will be topped up if need be.
When the area is numb, an incision will be made from the back of the vagina down, and to one side. It's done very quickly and hopefully it will help to bring your baby into the world shortly afterwards.
The cut can bleed quite a bit to start with, and this can look a bit scary if you can see it, or it can be scary for your partner. But don't fret too much, you will be being monitored closely and pressure will be applied to slow the bleeding.
Within an hour or so of your baby being born, the cut that was made will be stitched back up, most likely using dissolvable stitches, which will simply melt away in time. That means they won't need to be removed later.
As the anaesthetic wears off, you are likely to feel sore down there, understandably. But the pain will be managed for you in the hospital and once you go home with new baby (who really will be worth it!), you can take painkillers until everything settles down.
Can I do anything to avoid an episiotomy?
Hmm, well... the official line from the NHS is, no. That is simply because it doesn't believe there is enough evidence to suggest the chances of an episiotomy can be reduced.
However, there is some research which suggests that perineal massage in the final six weeks of pregnancy can go some way to reducing the risk, and many midwives believe it can help, too if performed ever day.
So, if you're worried about needing an episiotomy, there would be no harm in trying.
It might not be the easiest thing to do when you have a huge bump, so you might want some help from your partner.
• Dip your finger tips and thumbs in a cup of olive oil. Try to get into a comfortable position.
• Place both your thumbs about about 3cm inside your vagina. Gently push downwards, towards your anus.
• Now, still pushing down, slide either thumb to the side, so it feels like you are making a U-shape. You should be able to feel that stretching sensation, and it might tingle.
• Hold the stretch for a minute or two.
• Finish by massaging the lower wall of you vagina.
Read more about caring for yourself after an episiotomy here.
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