A Stitch In Time

An episiotomy is a procedure that is sometimes done just before delivery. An incision is made in the area between the anus and the vagina known as the perineum. This serves to enlarge the vaginal opening and ease the baby's exit from the vaginal canal.

For many years, the medical community thought an incision preferable to the mother sustaining vaginal tears. It was believed that an incision would heal better and faster than a tear. Current research, however, has shown that the opposite is true so that episiotomies are no longer routine.

An episiotomy may be performed under the following conditions:

*There is a need for immediate, urgent delivery.

Non-Standard Position

*The baby is in a non-standard position.

*The baby head is larger than the vaginal opening.

*There is fetal distress.

Forceps Delivery

*A forceps or ventouse (vacuum) delivery is necessary.

*The mother is too tired to push or can't control her pushing.

It's sometimes possible to soften the tissues in advance of the birth to lessen the chances that an episiotomy will be necessary. Six weeks before your due date, begin perineal massage. Wash your hands and lubricate your thumbs with olive oil or an OTC lubricant.

Vaginal Massage

Place your two thumbs just inside the opening of your vagina and press in a downward motion in the direction of your rectum. Hold this position for 1-2 minutes. Next, massage the bottom half of your vagina in a slow circular motion for ten minutes. Do these maneuvers twice daily until the delivery. If you find it difficult to reach your vagina, you can ask your partner to massage you.

Regular Kegel exercises that serve to strengthen the muscles of the pelvic floor may also prevent an episiotomy. Other things to try: warm compresses during labor and standing or sitting on a birthing chair or stool during delivery, rather than remaining in a prone position.

If you wish to avoid an episiotomy, make this clear in your birth plan. Your medical status may make it impossible for the doctor to safely honor your wishes, but if you make your wishes known, the doctor will try to avoid performing the surgery if at all possible.

Six Weeks

If you do require an episiotomy, it will take around six week for complete recovery. The stitches used for the procedure dissolve on their own. Some tips on episiotomy care:

*Rinse the area with warm, not hot water every time you urinate. You can use a squirt bottle for this purpose. Pat dry, don't wipe.

*Don't strain during bowel movements. Ask the doctor for a stool softener to ease movements.

Severe Pain

*Watch for signs of infection. Call your doctor if the area feels hot to the touch, becomes swollen, or you feel severe pain.

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