Heads up to www.wikipedia.com for the image.What is an episiotomy?
--An episiotomy is an incision, either straight down (midline) from the vaginal introitus (opening) towards and into the perineum, or is a medio-lateral incision off to the right or left side.
Why would an episiotomy be indicated or needed?
-- If there is an urgent or emergent need to deliver the baby quickly, and time is of the essence, then an episiotomy might be necessary. If, however, the mother is pushing well, and the baby is tolerating labor fine (no distress), then an episiotomy is not needed.
-- If the woman has undergone female genital mutilation, she may not physically be able to stretch her vaginal introitus to allow the passage of the baby during birth.
Should an episiotomy be required at all births?
-- Absolutely NOT! It should not be a routine intervention at any birth. It is a surgical procedure.
Will I feel the incision?
-- Most of the time, no. Sometimes the coverage from an epidural will numb the area enough. Other times, a local anesthetic is needed in addition to an epidural to help numb the skin and muscle. Or, if the woman does not have an epidural, local anesthetic would definitely be required before cutting an episiotomy.
How is an episiotomy repaired?
-- A type of suture that dissolves in about 3 weeks is used to help bring the muscles and skin back into correct anatomical position.
How long does it take to heal from an episiotomy?
--It can take several weeks (3-4 weeks, or more) to heal from an episiotomy. It takes approximately 3 weeks for the sutures to fully dissolve, and it will probably take several more weeks for the incision to completely finish the healing process. In general, it takes longer to heal from an episiotomy (a straight line/cut) than it takes to heal from a laceration (a jagged tear).
How long will I have pain and discomfort?
-- It can take 6 weeks or more for the pain to totally dissipate from an episiotomy. Always contact your care provider if you have severe or worsening pain.
What does an episiotomy scar look like when it is healed?
-- It should look like a scar as you would have anywhere else on your body. At first, the healed incision will look pink as it develops granulation tissue as part of the healing process. It might look like this for several months. Eventually, the scar will fade in color until it's a white/gray appearance. An old episiotomy scar can usually be seen as a faint white/gray line on the perineum when a woman is pushing out her next baby.
22 comments:
That picture always makes me WINCE! They showed a photo last week during our Postpartum lecture of an episiotomy being cut, and I swear you could see every girl in the room snap her legs shut at the speed of light!
Try 10 months. Yeah, I am not exaggerating. Pain under the slightest stretching or pressure for TEN. FULL. MONTHS. And it was a tiny incision. One of my midwives told me it was the smallest ep. scar she had seen in 25 years.
Oh, and that was to deliver a less than 7 lb baby, who was not in distress, the doc just wanted to get to the office so he would not be behind that day.
Funny how my midwife (same practice, different midwife, and since she caught my boy she is 'mine') helped me deliver my almost 9 pounder with a less than 1 cm first degree a couple years later.
Episiotomies are evil. And I don't think my pain experience or my why it was done experience is all that unusual. I personally know 4 women who had to have laser surgery or be re-cut due to botched stitching. And I don't know anyone that has said they are okay in 6 weeks. I DO talk about this, since I have found sharing my story with new and not so new Moms brings on many "wow, I thought it was just me" moments...
Very thorough. Thank you for taking the time to educate us! I wish I had found these blogs when I was pregnant! Count me in among the women who were hurting for months... About three months or so for me. Our poor husbands...!
Didn't get cut, had 2nd degree tearing - it took until about tow years to not be uncomfortable. What is not said here is that with nursing exclusively your vaginal walls are thinner and not as lubricated which can make the scar more uncomfortable for longer.
"In general, it takes longer to heal from an episiotomy (a straight line/cut) than it takes to heal from a laceration (a jagged tear)."
This absolutely is not true. A well-cut, and well-sutured episiotomy causes a lot less trouble than a tear, and in 40 years I have never seen the problems I've seen with lacerations. You note I write "well cut and well sutured" Many episiotomies are done too early and with blunt scissors, and suturing technique can leave a great deal to be desired.
To Homebody:
Did you not realize that your perineum isn't the same with a second baby, which is why you had a larger baby and didn't require an episiotomy? As a midwife myself, I'd love to take the credit for your midwife being able to avoid it, but really it was just one of the differences between first births and subsequent ones.
Different women have different pregnancies, labors, and may or may not need episiotomies. There is no "one size fits all" in OB.
My epidural gave out just in time to push and feel every bit of the episiotomy that I had no idea was coming. That was terrific. Ring of fire was nothing compared to the burning sting of the cut. Then, to top it all off, I guess was my body was done with the drugs, and the two two shots of local wouldn't take, so I had the pleasure of feeling each stitch. The only good thing I can say is that the repair was done well.
For my second, I had small tear which needed three stitches, but I felt much better and this different doc never thought of cutting me.
Ow.
Ow ow.
Ow.
My own personal experience: I had an episiotomy with my first - took about 6 weeks to be back to feeling normal, although, I did have intercourse before 6 weeks PP. 2nd child - I started to tear, the MD cut an episiotomy along the tear. Baby #2 was my biggest baby. Once again, about 6 weeks to feel normal again. Also resumed intercourse before 6 wks PP. 3rd child - no tears, no epis. Felt back to normal within a week.
I had a second degree tear with my first and third births (I tore very slightly with my 2nd, but didn't need stitches). I'm 13 days postpartum from birth #3 right now and my tear gives me minimal discomfort. I had minimal discomfort from my first tear as well.
The second birth may be different than the first (obviously) but AYC is correct when she says that tears heal better than cuts. That is because it is easier to accurately approximated the tissues with jagged lines that fit together like puzzle pieces than smooth lines from a blade that may slip by tiny amounts. Those tiny inaccuracies DO add up to future pain, and many women simply don't realize it's not SUPPOSED to feel that way so they never speak up to their care providers about it. That's probably why you don't think anyone has had issues from routine epis.
Considering that in the last 15 years over 900 separate studies (involving over 15,000 women) have concluded that episiotomy is only helpful in very, VERY emergent situations, there is simply no excuse for so many women to still be scarred from them a decade into the 21st century.
When I was in school, they told us that third degree tears and rectovaginal fistulas were caused by episiotomies. When you tear, you tear along skin and subcutaneous tissue, and only in extreme cases does the stronger muscle and fascia tear; whereas when you cut, you cut through the muscle and weaken whatever support the tissue has, which can to more dangerous tearing than occurs naturally.
I also think tearing is positional; you can't push against yourself and gravity on your back and not expect to tear with little seven pounders.
Antigonos - too many poor birth practices are blamed on a woman's being a primip. I don't buy it. An obstetrician needs (or should need in a perfect world) serious justification to cut a woman. The fact that he didn't justify or explain it to her is not a good indication.
man-nurse: Thank you. Thank you. Thank you.
Antigonos: See, the thing is, my husband and I were ACTUALLY THERE for both births. You were not. My daughter was out to her ears when the doc cut me. My husband did not even have time to finish the exclamation, "WHAT ARE YOU DOING??!!" before the doc grabbed scissors, snipped me, and my daughter came FLYING out (DH's words, and he is not prone to exaggeration).
You can blame my body all you want, but the absolute, 100%, iron clad reason I was cut was a crappy decision by the OB. Or maybe he is a crappy OB, I found out later from one of my girl friends that worked L&D in that hospital that he cuts most of his vag. deliveries...
OMG OMG LALALALALALALALALA OMG OMG LEAVING NOW LALALALALALA OMG OMG
I was cut with my first baby. He was 10 weeks early. After it was obvious that labor was not going to stop, the doc told me he was going to numb the area for an epiiotomy (no epidural) and I protested. He told me it was for the baby and of course hearing that in the stress of the moment, I let him do it. I have only read in one article that episiotomies might help preemies who's skulls are a bit softer than a full term infant. So not sure if that played into it or not. It didn't take very long to heal luckily. Only slight tearing with babies 2 and 3 (both full term).
it's really baffling to me that there's even discussion about whether cuts or tears are worse. even if tears were worse--definite cut vs. chance for a tear? I'll take the chance over the definite. and I did. 4 babies later (ranging from 8 to nearly 11 1/2 lb) I have never had a stitch in my life.
I was young when I had my son. My son wasn't a big headed baby I believe my GYN was just impatient. My son was in NO distress and I had only labored for 6hrs!
I got an epi and I've had issues off and on for 18yrs! I told my midwives for my next two let me tear DO NOT CUT ME...I told them that at my first visit after finding out I was pregnant. Told them to let me stretch NATURALLY and then let me tear if need be. The massaged and stretched me and no more epis for me!
YAY!
While people keep saying a cut is better than a tear, it has to be well done (the cut) and oft times it's simply is not.
I had less pain with my c-section (baby #2) than with my epi (baby #1). The epi pain was Horrible! On-Call Doc acted like I was insane when I complained about it. And prior to birth, I had told my OB Dr. over and over not to do it. And I told my husband to fling himself between me and the Dr. if he got out the scissors. Neither listened. Dr. decided I needed a vacuum and to do that he declared I needed the epi. I was too befuddled to fight him. I am still pissed about it 6+ years later.
I am still wondering why my OB gave me and episiotomy with my first born who was only 6 lbs 12 oz? I had ONE stitch. So odd. Seemed to me that was not necessary. And yes, it did hurt.
Blessings!
Dawn
I had second degree tearing and an episiotomy for a very emergent situation with no pain meds (epidural or local). Yes, it hurt, but the baby did fine once she was out (the most important thing). The part I didn't understand was why I couldn't have pain meds for the stitching up thereafter...
As an L&D nurse, this morning I witnessed an epis cut without anesthesia. Primp, 34-weeker, variables to 50's with pushing. Was there time to grab the local and infiltrate the perineum? Depends on who you ask, I guess. I am angry over the situation and at myself for not thinking quickly enough on my feet to stop it.
I've had women tell me that months and years after episiotomies they still felt pain. I've never had a woman do that with a natural tear. I'm sure there are women out there that experience that..but they aren't coming to me.
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