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Episiotomy for the Safety of Babies During Childbirth

An episiotomy is an incision made in the perineum (the tissue between the baby's birth canal and the anus) during labor. In the past, episiotomy was thought to reduce the risk of a tear in the birth canal and keep the mother's bladder and rectum in place after the baby was born. But now research has proven that these benefits are not proven. Check out the further explanation regarding the following episiotomy.

An episiotomy is a relatively simple procedure. The doctor or midwife will inject local anesthesia into the area around the vagina so that the mother does not feel pain. The doctor will then make an incision which will then be sewn after the baby is born. The main purpose of an episiotomy is to enlarge the birth canal so that the baby is freer to be born. An episiotomy is also usually done to prevent severe vaginal tears during childbirth.

Although once considered a mandatory procedure in labor, episiotomy tends to be recommended today only in certain conditions, namely:

  • Fetal distress, which is if the baby does not get enough oxygen and must be removed immediately to avoid the risk of being born dead or deformed. Fetal distress is marked by a drastic increase or decrease in the baby's heart rate.
  • Give birth to a big baby. Giving birth to a baby who is tall or large is at risk for prolonged labor. An episiotomy will be needed to widen the birth canal in this condition.
  • Other instruments such as forceps or vacuum need to be used to remove the baby, so the vagina needs to be widened.
  • The baby's position is not normal. Babies in positions such as breeches and abnormal head positions may need to be born with the help of an episiotomy to facilitate the doctor or midwife in assisting the delivery process.
  • Complications for the mother, if the mother has a serious illness, such as heart disease, so the delivery process needs to be done as short as possible. Or if you are very tired because you have been pushing for hours.

Post-Episiotomy: Treating Pain during Recovery

An episiotomy will generally leave the mother with pain for several weeks, especially when walking, sitting, and urinating. The doctor will suggest delaying some activities during this time to facilitate the healing process. Here are some ways you can do to reduce pain or speed up the healing process.




  • Occasionally, cold compresses in the area of the former episiotomy to relieve pain. Avoid placing ice directly on the scar. We recommend that you wrap the ice in a cloth first before using it to compress.
  • Use a donut-shaped pillow to comfort yourself when sitting.
  • Leave traces exposed to the air. Take off your underwear and lie on your bed for 10 minutes, once or twice a day.
  • Post-episiotomy, some women will feel the pain that greatly interferes with their daily activities. Pain medication can be taken to alleviate it. Paracetamol is safe to use for nursing mothers, while ibuprofen is not recommended for consumption if the baby is born prematurely (before 37 weeks), is born too underweight or with certain medical conditions. The use of aspirin is not recommended because it can be contained in breast milk.
  • After urinating, wash the vagina with warm water. Meanwhile, after defecation, clean the area with a front to back movement (from the vagina to the anus) to prevent the bacteria in the anus from infecting the stitches. You can also splash warm water during urination into the vagina to reduce pain. Using a squat toilet will relieve pain when urinating more than using a toilet seat. Consumption of laxatives in low doses if bowel feels very painful or constipated so that the stool more easily removed. But before taking it, you should consult your doctor first.
  • Having sex. Generally, 4-6 weeks is the time it takes for the episiotomy wound to heal. But there is no certain standard when women who undergo episiotomy can return to sex. Then you should take as long as necessary until you feel completely recovered.
  • Body exercise with pelvic exercises can strengthen the muscles around the vagina and anus thereby reducing pressure on the incision and in the surrounding tissue.

Take care not to let the wound become infected. This condition is characterized by pain that does not go away in the wound area, red skin and swelling around the wound suture, fever, pus also comes out of the stitches. If this situation occurs, consult a doctor immediately.

What Must Be Done to Avoid Episiotomy?

The perineum can stretch well, but it can also tear. The midwife or doctor can help prepare so that you don't have to undergo an episiotomy during labor. Breathing and blowing exercises are one of them. This is necessary so that the baby's head can come out slowly, allowing the perineal skin's muscles to expand without tearing.

Research shows that massaging the perineal area a few weeks before delivery (at least after 35 weeks of gestation) can reduce the risk of episiotomy during childbirth. Massage is generally done at least twice a week by inserting one or two fingers into the vagina, then pressing it toward the perineum. This process is known as a perineum massage that can be done alone in the following ways:

  • Wash your hands with warm water and soap. Make sure your nails have been cut short.
  • If needed, you can smear the tip of the thumb with a lubricant.
  • Place the finger inside the vagina, press gently for two minutes and repeat the message for up to 10 minutes.

The midwife may also suggest warm compresses on the tissue between the vagina and anus to soften the perineum and prevent tears during labor.

In the end, no woman wanted to undergo an episiotomy. But the conditions at the time of labor can change immediately. Always remember that an episiotomy is sometimes needed for the smooth and safe mother and baby in labor.





References

References

  1. Mayo Clinic (2015). Labor and Delivery, Postpartum Care. Episiotomy: When it's needed when it's not.
  2. Junior, C. & Júnior, P NCBI (2016). Selective Episiotomy: Indications, Technique, and Association with Severe Perineal Lacerations.

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Health and clinical interests include all aspects of infectious diseases

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