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Episiotomy is a surgical incision made between the vagina and anus to widen the vaginal opening for childbirth. It is usually performed when the baby's head has stretched the vaginal opening to several centimeters. The procedure is often carried out during the second stage of labor, i.e., the pushing stage, and is done to prevent severe tearing of the perineum as the baby is delivered. The cut is then stitched up and covered with a dressing. Episiotomies can lead to increased bleeding due to muscle involvement, and there is also a risk of the incision extending to higher-order perineal lacerations.
| Characteristics | Values |
|---|---|
| Definition | A cut (incision) through the area between the vaginal opening and the anus |
| Procedure | The incision is made during the second stage of labour (pushing stage) when the baby's head is visible and the perineal muscles are stretched thin. |
| Purpose | To make the vaginal opening larger for childbirth, aiding the delivery of the baby. |
| Types | Midline episiotomy, Mediolateral episiotomy |
| Muscle Involvement | Mediolateral episiotomy involves the bulbocavernosus muscle and transverse perineal muscle. |
| Repair | Stitches are used to repair the perineal tissues and muscles. |
| Complications | Bleeding, pain, infection, hematoma, scarring, obstetric anal sphincter injury, Levator Ani Muscle (LAM) injury |
| Prevention | Adequate anesthesia, precise timing, and technique are necessary to minimize complications. |
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What You'll Learn
Episiotomy procedure
An episiotomy is a surgical procedure performed during childbirth to widen the vaginal opening and aid in the delivery of the baby. It involves making an incision in the perineum, the area between the vaginal opening and the anus. The procedure is typically carried out during the second stage of labour, also known as the pushing stage, when the baby's head has already started to stretch the vaginal opening.
There are two main types of episiotomy: a midline episiotomy and a mediolateral episiotomy. A midline episiotomy starts close to the midline of the perineum and extends downward in a straight line. On the other hand, a mediolateral episiotomy begins similarly but extends laterally, either at a 45-degree or 60-degree angle, avoiding the midline and sphincter. The type of episiotomy performed depends on the condition of the patient and the healthcare provider's practices.
Before the procedure, if the patient has not received any anaesthesia, a local anaesthetic will be administered to numb the perineal skin and muscle. If an epidural anaesthesia is used, additional anaesthesia is not required. The healthcare provider will then use surgical scissors or a scalpel to make the incision. Once the baby and placenta are delivered, the healthcare provider will stitch the incision using continuous, non-locking sutures to minimise pain and promote healing. Dissolvable stitches are used, eliminating the need for patients to return to the hospital for their removal.
After the procedure, patients may experience pain, swelling, and soreness at the incision site. To alleviate these symptoms, patients can apply ice packs, take warm or cold shallow baths (sitz baths), and use medicated creams or local numbing sprays. Patients should keep the incision area clean and dry, especially after urination and bowel movements. Strenuous activity and heavy lifting should be avoided, and patients should follow their healthcare provider's recommendations regarding sexual activity and the use of tampons.
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Episiotomy repair
An episiotomy is a surgical procedure performed during childbirth, where an incision is made to widen the vaginal opening and ease the baby's delivery. The procedure is often carried out when the baby's head has stretched the vaginal opening to several centimetres. It is important to make a surgical incision to avoid tissue tear and ease delivery.
- A thorough examination of the perineum is conducted to evaluate the extent of the laceration and identify any possible extension to third- or fourth-degree lacerations.
- The repair is initiated by placing a suture approximately 1 cm proximal to the apex of the laceration within the vagina.
- The hymen is reapproximated with a nonlocked suture, which is then tucked through the hymenal ring posterior to the perineal body.
- The muscular tissue of the perineal body is reapproximated using interrupted suturing techniques. This includes a "crown stitch" of the bulbocavernosus muscles and interrupted or running sutures of the transverse perineal muscles.
- The suture is then run posteriorly to the posterior apex of the incision to reapproximate the remainder of the perineal body.
- A subcuticular skin closure is performed anteriorly, followed by securing the suture with a knot inside the hymenal ring.
- The repair should be performed in a setting with appropriate instruments, lighting, and exposure, such as a labour and delivery room or an operating room.
- It is important to use the smallest-diameter suture that provides adequate tensile and knot strength for the repair.
- Various suture materials can be used, including chromic catgut, synthetic materials, and braided standard or rapid-absorption polyglycolic acid sutures.
- The repair should be followed by proper postpartum care and monitoring for potential complications such as wound infection, dehiscence, or rectovaginal fistula.
- Patients who have undergone OASIS repair may require stool softeners or laxatives for 6 weeks to prevent wound complications and should be closely monitored during postpartum recovery.
It is important to note that the repair procedure may vary depending on the specific circumstances and the healthcare provider's practices. Additionally, the optimal time for performing an episiotomy remains a subject of debate, with most surgeons recommending making the incision immediately before delivery.
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Episiotomy incision
An episiotomy is a surgical incision made during childbirth to enlarge the vaginal opening and aid delivery. It involves cutting through the perineum, the area between the vagina and anus, to prevent tearing of the vaginal tissue as the baby's head emerges. The procedure is usually performed during the second stage of labour, when the baby's head has stretched the vaginal opening to several centimetres.
The incision typically starts at the posterior fourchette, extending along the midline through the central tendon of the perineal body. The cut is made at an angle ranging from 0 to 25 degrees, extending to about half the length of the perineum. In some cases, additional transverse incisions may be made bilaterally above the anal sphincter to further increase the vaginal outlet diameter.
The episiotomy procedure can vary depending on the condition of the mother and the healthcare provider's practices. It is often performed under local anaesthesia to numb the perineal skin and muscle before the incision. Surgical scissors or a scalpel is used to make a single, deep cut during a contraction when the perineal muscles are stretched thin.
After the delivery, the episiotomy site is stitched closed using dissolvable sutures. Proper repair of the incision involves reapproximating the muscular tissue of the perineal body, including the bulbocavernosus and transverse perineal muscles. The repair technique aims to minimise complications such as bleeding, infection, and scarring, which can lead to long-term issues.
To promote healing, it is important to keep the incision clean and dry. Warm or cold shallow baths (sitz baths) can help ease soreness and speed up healing. Pain relievers, such as paracetamol or ibuprofen, can be taken as recommended by a healthcare provider to manage any discomfort.
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Episiotomy complications
Episiotomy is a cut (incision) through the perineum, the area between the vaginal opening and the anus, to make the vaginal opening larger for childbirth. It is usually done when the baby's head has stretched the vaginal opening to several centimetres.
While episiotomy was once considered a normal and healthy procedure during vaginal deliveries, it is no longer accepted medical practice for normal, uncomplicated pregnancies. This is because natural tears, which occur in 40% to 85% of vaginal births, typically heal better than surgical incisions.
However, there are still situations where a healthcare provider may advise an episiotomy, such as fetal distress, breech position, or shoulder dystocia. In such cases, it is important to be aware of potential complications, which can include:
- Bleeding: The perineum and surrounding tissues have an extensive blood supply, which is increased during pregnancy and labour. A mediolateral episiotomy may result in more bleeding than a midline episiotomy due to muscle involvement.
- Pain: The healing process after an episiotomy can be painful and difficult, especially with a mediolateral episiotomy.
- Higher-order perineal lacerations: The risk of third- or fourth-degree lacerations is higher with an episiotomy, especially a midline episiotomy, which may extend into the rectum.
- Hematoma formation: While rare, deep hematomas can cause significant maternal morbidity if they dissect proximally toward the upper vagina and the broad ligament.
- Dyspareunia: Some studies have investigated the long-term effects of episiotomy on sexual function, with one finding that routine episiotomy did not reduce rates of dyspareunia (painful sexual intercourse).
- Urinary and fecal incontinence: There is conflicting evidence regarding the impact of episiotomy on urinary incontinence, with some studies finding no significant difference between women who underwent the procedure and those who did not. However, there is limited data on long-term complications, and the potential impact on fecal incontinence warrants further investigation.
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Episiotomy pain relief
An episiotomy is a cut (incision) through the perineum, the area between the vaginal opening and the anus, to widen the vaginal opening for childbirth. It is usually carried out when the baby's head has stretched the vaginal opening to several centimetres.
Episiotomies can be a source of significant pain and discomfort, and there are several recommended methods for pain relief and to aid healing. Most women heal without problems, but it may take many weeks.
Ice Packs and Sitz Baths
Applying ice packs to the affected area can help reduce swelling and pain, especially in the immediate aftermath of the procedure. Sitz baths, where the perineal area and buttocks are submerged in warm water, can also help to heal wounds and relieve pain, itching, and muscle spasms.
Infrared Therapy
Infrared therapy is a treatment that uses infrared radiation to expose the incision site to a light source. This facilitates pain relief and wound healing by increasing blood supply to the area, improving the tissue's access to nutrients and oxygen, and reducing inflammation.
Medication and Topical Treatments
Painkillers such as paracetamol, ibuprofen, or acetaminophen can help relieve pain and are considered safe when breastfeeding. Medicated creams or local numbing sprays may also be recommended by a healthcare provider, along with stool softeners if bowel movements are painful.
Other Considerations
It is important to keep the cut and the surrounding area clean to prevent infection. Squatting over the toilet, rather than sitting, may reduce the stinging sensation when urinating. Kegel exercises, perineal care, and the topical application of dry heat can also aid in recovery.
Pain during sex is common in the first few months after an episiotomy, and a water-based lubricant can help. It is important to be open and communicate with your partner to maintain a healthy sex life.
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Frequently asked questions
An episiotomy is a cut (incision) through the area between the vaginal opening and the anus, known as the perineum. This procedure is done to make the vaginal opening larger for childbirth.
An episiotomy is performed during the second stage of labour (pushing stage), during the crowning of the fetal head.
Yes, an episiotomy cuts through the perineal muscles. The procedure may also involve the repair of the bulbospongiosus muscle, the bulbocavernosus muscle, and the transverse perineal muscle.
After an episiotomy, the cut is stitched together using dissolvable stitches. The cut may bleed quite a lot at first, but this can be controlled with conservative measures such as compression. Ice packs can help reduce swelling and pain.
Yes, bleeding is one of the most common complications of episiotomy. Other possible complications include infection, hematoma, and scarring, which can lead to long-term issues like dyspareunia.
