Understanding Episiotomy

We recently received a letter from a reader saying she had an episiotomy when her baby, who weighed 4.3kgs, was born. Of her greatest concern was whether she would be able to resume normal sex as the episiotomy scar still hurt. She also wanted to know more about episiotomy and why it became necessary in her case. To answer her as well as other readers, we sought expert advice on episiotomy. What is an episiotomy? An episiotomy is a deliberate surgical incision carried out on tissue between the vagina and the back passage near the anus to allow delivery when the vaginal entrance does not stretch enough to accommodate the baby’s head, or there are other concerns during normal delivery.

What necessitates an episiotomy?

According to Dr. David Kiragu, an obstetrician/gynaecologist based at IPS building, Kimathi Street, Nairobi, an episiotomy may be done if the baby is distressed or needs to be born quickly or if there are signs the mother is not coping too well with labour.
An episiotomy helps to increase the size of the opening of the vagina to assist in the delivery of the baby. It can be performed for many reasons including:

• If the baby’s heart rate shows signs of not tolerating the last few minutes of labour and needs to be delivered as soon as possible.

• To help decrease the amount of pushing by the mother during delivery if she is showing signs of loss of energy. It also helps eliminate dangers, which may be caused by spontaneous or extensive tear as a result of a difficult childbirth.

• To avoid a vaginal tear, a doctor may perform an episiotomy just before delivery or during the course of labour. This gives the woman a clean incision that is easier to heal than a spontaneous one.

• If the baby is big and the doctor feels that he needs more room to allow for safe delivery.

• If the doctor is required to use forceps to help deliver the baby and, therefore, needs additional room to fit the forceps.

How is an episiotomy done?

An episiotomy is usually a very simple operation. Local anaesthesia is used to numb the area around the vagina to ensure the mother does not feel pain. The doctor or midwife makes a small, diagonal cut from the back of the vagina, directed down and out to one side. This is called a mediolateral episiotomy and does not involve muscles around the rectum or the rectum itself.

How is the episiotomy repaired?

After the birth of your baby, the cut is stitched using dissolvable thread to restore the anatomy of the perineum(area between anus and vagina).

Are there any complications associated with an episiotomy?

There may be an experience of pain, especially if the cut is done as an emergency before local anaesthesia has fully taken effect. Bleeding occurs and there is a possibility of infection if the wound is not hygienically taken care of. Some women may experience pain and swelling and there could also be some defects in the closure of the wound. There is a likelihood of short-term sexual dysfunction. Episiotomy may also increase the risk of incontinence.

How long does episiotomy take to heal?

The duration varies from person to person. Some women say that pain reduces within a week, while others continue experiencing pain and discomfort for about six weeks. Using ice packs on the perineal area during the healing period helps numb the area, reduce swelling and also aids in recovery.

Does an episiotomy affect one’s sex life?

Once the stitches have healed and there is no discomfort, it is alright to make love. There may be some initial feeling of tenderness and tightness but this will disappear in a few weeks. Relaxing while making love will ease the discomfort. Using a lubricant such as K-Y Jelly may also help. Taking a warm bath before sex and also giving foreplay plenty of time will help improve your sex life.

Safety Tip:

Penetrative sex should be avoided for up to six weeks or longer after an episiotomy, to allow the wound to heal completely and also prevent pain and possible breakdown of the wound.