Surgical incision in the perineum during childbirth: Definition, process, aftercare, and recovery
In the context of childbirth, an episiotomy is a surgical procedure where a doctor or midwife makes an incision in the perineum to facilitate delivery in specific circumstances. This procedure is not routinely performed, but reserved for situations where it provides a clear benefit, such as preventing severe perineal tearing or hastening delivery in cases of fetal or maternal distress [1][2][4][5].
Before an episiotomy, anesthetic is usually administered to minimize discomfort, unless the person has already had an epidural. After delivery, the incision is repaired with dissolvable stitches to control bleeding and promote healing [4].
While an episiotomy can help in certain situations, it's important to note that it may cause pain and discomfort for 2-3 weeks, with the incision healing within a month. To relieve this pain, a person can use ice packs, over-the-counter pain medications, allow the wound to get fresh air, pour water over the wound while urinating, eat a fiber-rich diet, drink lots of water, take stool softeners, and avoid penetrative sex until the pain subsides [2][5].
Current guidelines recommend a judicious use of episiotomies, allowing natural perineal stretching when possible, as minor tears generally heal faster and cause less postoperative pain than an episiotomy incision [2][5]. If pain or any other symptoms continue for longer than 3 weeks after an episiotomy, a person should speak with a doctor.
It's also crucial to be aware of the risks and complications associated with episiotomies, which include swelling, infection, blood loss, bowel incontinence, vaginal prolapse, Bartholin's abscess, rectovaginal fistula, psychological trauma, dyspareunia, and hematoma [6]. If signs of infection develop after an episiotomy, such as swelling, pus, or an unusual odor, a person should seek medical care as soon as possible.
The American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) both recommend that episiotomies be performed only when medically necessary [3]. In some countries, rates of episiotomies have been declining, but can still be high in others. For example, a 2021 study in Ethiopia found that 410 out of 410 participants underwent episiotomies, which is significantly higher than the WHO recommendation of 10% [7].
If you're planning for childbirth, discussing the necessity, types, benefits, risks, and alternatives of an episiotomy with your obstetrician or midwife is a good idea. Following postoperative care instructions carefully is also important to prevent complications.
Remember, an adult capable of giving informed consent can refuse an episiotomy. The perineum, a diamond-shaped structure in females that extends from the posterior end of the vulva to the anus, should stretch during childbirth to accommodate the passage of the baby.
Sources: [1] ACOG Practice Bulletin No. 175: Episiotomy. (2016). Obstet Gynecol, 128(6), 1289-1301. [2] Episiotomy. (2021). BMJ Best Practice. [3] Episiotomy. (2021). The World Health Organization. [4] Episiotomy. (2021). Mayo Clinic. [5] Episiotomy: What You Need to Know. (2020). Cleveland Clinic. [6] Complications of Episiotomy. (2019). Medscape. [7] Episiotomy practices during childbirth in Ethiopia: A systematic review and meta-analysis. (2021). BMC Pregnancy and Childbirth, 21(1), 1-10.
- A person might expect to experience some pain and discomfort after an episiotomy for 2-3 weeks, and can plan to use health-and-wellness products like ice packs, over-the-counter pain medications, and stool softeners to ease the discomfort.
- In the health-and-wellness field, it's essential for parents to understand the risks associated with episiotomies, which include complications like swelling, infection, and psychological trauma, and to discuss the procedure's necessity with their obstetrician or midwife.
- The science of childbirth is continually evolving, and parents may find it beneficial to expect a more natural childbirth process, allowing for the perineum to stretch on its own, as this can lead to faster healing and less postoperative pain compared to an episiotomy incision.
