An episiotomy is a small surgical cut made in the perineum, which is the region between the vagina and anus, which can be performed at the end of the second stage of labor, with the aim of widening the vaginal opening when the baby’s head is about to descend, facilitating the baby’s exit and preventing possible serious injuries to the perineum.
Although this technique was used in almost all normal births to avoid tearing of the skin that may occur with the effort of childbirth, currently, According to the Brazilian Federation of Gynecology and Obstetrics Associations and WHO, not performing an episiotomy is always the first option, as there is no scientific evidence that defines the indication for this procedure.
However, in some cases, episiotomy may be recommended by the obstetrician and carried out selectively when strictly necessary, as in addition to being very painful, it can also pose risks such as urinary incontinence or infections, for example. In these selected cases, the episiotomy is performed under local anesthesia, with a specific technique and the woman must agree and sign an informed consent form.
When can it be recommended
Episiotomy may be recommended by the doctor, and the woman must agree to the procedure and sign the free and informed consent form for natural birth, which contains information that episiotomy may occasionally be necessary and the complications that may arise.
Thus, episiotomy may be indicated in some selective cases, according to the obstetrician’s assessment during childbirth, and include:
- Very high risk of serious lacerations in the perineum, which can reach the intestine;
- Fetal distress;
- Premature fetus;
- Baby weight over 4 kg;
- Failure to progress labor.
Episiotomy is generally decided by the medical team during childbirth, but the pregnant woman can make it clear that she does not approve of this type of procedure and, in this case, the doctor should not perform the episiotomy.
Episiotomy is considered obstetric violence when it is carried out without the woman’s prior consent, and therefore, if it is necessary to perform it, the doctor must inform the woman that she must authorize the procedure, after being informed of the need for the procedure and the possible scratchs.
How it is made
The most recommended technique for performing an episiotomy is the mediolateral one, in which a lateral cut is made in the perineum region, offering less risk of tearing the anal region. However, it is more painful and more difficult to heal.
Another technique, which although not the most recommended, can be performed by an experienced medical team, is the median episiotomy technique, in which a vertical cut is made in the perineum towards the anus, which is easier to repair, but has greater risk of extending to the anus and causing complications, such as damage to the anal sphincter and fecal incontinence.
What is recovery like?
Recovery after episiotomy, on the first day, is carried out in the hospital under the supervision of the obstetrician, anesthesiologist and nurse. During this period, the doctor may prescribe painkillers for pain.
The stitches used in episiotomy are normally absorbed by the body or fall out naturally, meaning there is no need to return to the hospital to remove them and the region returns to normal after healing is complete.
However, some precautions are important during episiotomy recovery and to ensure good healing, such as keeping the intimate area always clean and dry.
Therefore, it is important to change the pad whenever it is dirty, maintain good hygiene in the intimate area and, whenever possible, avoid wearing pants or panties to avoid the accumulation of moisture.
Furthermore, to facilitate healing and reduce the pain caused by the episiotomy, you can also apply ice to the region and take anti-inflammatory medications prescribed by your doctor, such as ibuprofen or paracetamol, for example. See other care after episiotomy.
How long does it take to heal
Episiotomy healing time varies from woman to woman, being longer the larger the size and depth of the wound. However, the average time is 6 weeks after giving birth.
During this time, the woman can gradually begin her daily activities, without making excessive efforts and in accordance with the doctor’s instructions. Sexual activity should only be started after healing is complete.
Since the region may still be sore for longer, a good tip before trying intimate contact again is to take a hot shower to help the muscles relax.
Find out which foods accelerate episiotomy healing in this video by nutritionist Tatiana Zanin:
Possible complications
The main complications that can occur after episiotomy are:
- Injuries to the muscles of the intimate region;
- Hemorrhage or bleeding at the cut site;
- Pain or swelling in the scar;
- Injury to the urethra or urinary incontinence;
- Infection at the cut site;
- Increased postpartum recovery time;
- Rectus vaginal fistula;
- Injury to the sphincter or anal mucosa;
- Fecal incontinence;
- Chronic pain;
- Pelvic organ prolapse.
Additionally, pain may occur during intimate contact in the months following childbirth.
To prevent the development of some of these problems, women can perform Kegel exercises during recovery, as advised by their obstetrician. See how to do this type of exercise correctly.
Warning signs to go back to the doctor
It is important to consult an obstetrician or go to the nearest emergency room if symptoms such as fever, chills, bleeding or pus from the scar, or foul-smelling discharge appear.
These symptoms may indicate an infection and, in these cases, medical help should be sought immediately.
