Will it be painful, and how will it heal?
An episiotomy is a surgical incision that enlarges the vaginal opening to help deliver your baby. Normally the decision whether you need such a procedure is made solely by your doctor if you do not discuss it prior to delivery. It is carried out very quickly under local anesthetic so it is unlikely you will feel any pain. Common reasons given for the suggestion of an episiotomy are:
• If your baby's head is too large for your vaginal opening
• If you need forceps isted delivery
• If your baby is breech position
• If your baby is in distress, and the doctor tries to hurry up the delivery
The recovery period is another matter and you're quite likely to feel discomfort or pain as the wound heals, particularly in the first few days when the vaginal area is quite swollen. You can help recovery and ease discomfort in the same way that you would for natural tearing:
• Pour warm water on your perineum as you urinate as the water will dilute the urine so that it doesn’t sting the cut. Keep a spray bottle or cup in the bathroom for this purpose.
• During your first bowl movements you may like to support your perineum area as you may be worried that the stitches will tear. This is unlikely, but to ease your mind and help you relax you can use a clean sanitary pad to support your perineum (press lightly upwards) as you open your bowels.
• Make sure you include plenty of fiber in your diet during this period to help avoid constipation and uncomfortable bowel movements.
• Toilet hygiene is very important during your recovery period to reduce the risk of infection. Make sure you only wipe from the vagina towards the anus, NOT vice versa. You can also pour warm water over your vagina area after you urinate or have a bowel movement which will help keep the area clean.
• Take a shallow warm bath (pouring warm water over your upper body) preferably a herbal bath with healing herbs, to relax and promote healing. Keep bathing time relatively short as a long soak will make the perineal tissues soggy and could pose an infection risk.
• Change your maternity or sanitary pad frequently- at least every four hours, and ensure it’s firmly in place so that it doesn't rub against the stitches.
• Keeping maternity pads in the freezer will ensure they are cool and soothing when you put them on. Another option is to use a cooled gel pad on the area to help reduce swelling, particularly in the first couple of days. I you can avoid ice packs as you may get ice burn, but if you need to use them please wrap them with a cloth before placement on your stitches.
• Gently pat the vaginal area dry and don't rub your stitches as this will cause irritation. Make sure the area is dry before dressing.
• Exercise your pelvic floor - as soon as you can after the birth. Kegel exercises help speed up recovery by increasing blood flow to the area. Toning up the perineum will also help combat any post-natal problems you may have with incontinence (urinary leakage). Aim to do 50 to 100 every day.
• To speed up healing, let the fresh air in. Lie on the bed on an absorbent pad or old towels and remove your underwear and sanitary pad for at least ten minutes daily, or as often as you can. Fresh air always aids in healing wounds.
• Avoid standing or sitting for long periods as this puts pressure on the area. If you do need to sit for a while use a specially designed donut-shaped, perineum pillow.
The wound should heal within two weeks, but the area may be uncomfortable for a long time, even after superficial healing. If the wound continues to be very painful several days after the birth, if there is an unpleasant odor from the area, or if you have a fever, then you should contact your health-care provider. An episiotomy incision is usually fully healed by the time of your post-partum check six weeks after the birth, and is one of the things your doctor will examine.
There are many newly published studies on the risks and side effects of episiotomies. Results have been published that such a procedure is largely unnecessary and may make the very complications it is supposed to prevent much more likely. Also reported is the higher incidence of pain and side effects such as vaginal dryness and decreased libido. There have been reported incidences of the vagina being stitched up too tightly after birth thus reducing the size of the vagina and making sex painful for a long time.
Do your research, learn the side effects, discuss this procedure with your doctor extensively and determine if it is right for you.
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