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Everything You Need to Know About Episiotomy Repair

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Giving birth is a without a doubt one of the most beautiful aspects of life itself.  However, while you’re thinking of your birth plan, it’s important to consider the less attractive aspects – like the possibility of an episiotomy repair!

It would be ideal to have an easy recovery after giving birth, right? This guide will give you all the tools you need to not only understand the process but to reduce your chance for the episiotomy procedure.

But before we jump into an episiotomy repair, let’s first talk about what an episiotomy is.

What is an episiotomy?

According to obgyn.net, an episiotomy is a surgical incision made in the perineum during childbirth. This enlarges the vaginal opening to prevent unwanted tearing during birth.

If you get an episiotomy, doctors may perform two types of incisions during birthing. The midline consists of a vertical incision made in the middle of the perineum from the posterior fourchette (the thin fold of skin at the back of the vulva) toward the anus. The mediolateral incision is made at the posterior fourchette and continues toward at a 45-degree angle. (source)

In the 1930s many obstetricians believed that the procedure would prevent extensive tearing during birth. From that day on, it was considered standard practice.

Fast forward to 2005, the Journal of the American Medical Association released new evidence that the outcome of an episiotomy is worse than natural tearing.

“Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.” (source)

Also,

“…researchers have found strong evidence that tears heal easier and are less traumatic to tissue than episiotomies (Carroli and Mignini 2009).” // Evidence Based Birth

With this new understanding of birth and women’s bodies, the rate of the procedure has dropped from 25 percent in 2003 to 11.6 percent in 2012.

Today it is only performed in the most urgent situations such as:

  • The baby is too large and needs more room to exit.
  • He or she isn’t in the right position to pass through the birth canal.
  • There is a medical complication or distress towards the baby.
  • A forceps or vacuum delivery is needed.
  • The baby is preterm.

Here is an insightful video on Ina May Gaskin, internationally-known speaker, and America’s leading midwife.

Episiotomy Repair Surgery 

An episiotomy repair surgery is when the incision is sewn together after delivery. The tear is either classified as first, second, third or fourth-degree tears.

  • A first-degree tear is a tear in the vaginal and perineal skin only.
  • The second degree is a tear in the vaginal wall and underlying perineal muscles.
  • A third-degree tear involves the anal sphincter.
  • The fourth degree is a laceration to the perineum and the rectum.

Healing takes about 4-6 weeks depending on the size of the incision. Keep in mind that there are complications after getting stitches. This includes numbness, bleeding, swelling, infection, and pain during sex.

Mom in labour

https://pixabay.com/en/hospital-labor-delivery-mom-840135/

Episiotomy Repair Techniques

An episiotomy repair is critical. It is imperative that your obstetrician can successfully repair the open wound.

Common suture stitches

http://www.dolphinsutures.com/types-of-sutures

Repair techniques include buried mattress suture, lock suture, purse string suture, interrupted suture, and continuous suture. Two of the most sought out stitching techniques is the continuous suture and the lock suture method.

  • The continuous (non-lock) method: This method is simply a continuous stitch with a knot at the end of the closure.
  • The lock (interrupted) method: This method is simple as well, but the stitch is interlocked and knotted at the end.

According to the Cochrane Database of Systematic Reviews, it is proven that the continuous method showed quicker recovery time and less pain following an analgesic.

The continuous suturing techniques for perineal closure, compared with interrupted methods, are associated with less short-term pain, need for analgesia and suture removal. (source)

Unfortunately, there is no sure way that the procedure will heal as expected. Even with a perfect stitch, the wound will still be at risk to heal properly. Furthermore, a laceration in the perineum can cause further tear down to the rectum. Also, the wound may result in long term effects such a painful sexual intercourse and rectovaginal fistula (stool or gas passing through the vagina). To heal, there are things that you can do to ensure a timely recovery.

Aftercare consists of:

  • Sitz baths
  • Proper hygiene
  • High fiber diet
  • High water intake
  • Kegal exercises

Ice packs and ibuprofen works wonders to alleviate the pain. It is important to abstain from using a tampon, having sex or any strenuous activity that might rupture the stitches.

Maternity

http://www.mamamaternity.co.nz/step-by-step-guide/weeks-37-40/

Avoiding Episiotomies 

Fortunately, there are methods that you can do to reduce your risk of an episiotomy.

  • Perineal massage: A perineal massage helps with the elasticity of the perineum (the skin between your vulva and anus). It will increasingly raise your chances of a tear free vaginal birth. Check out our tips on how to correctly perform a perineal massage. 
  • Kegel exercises: Kegel exercises help strengthen pelvic floor muscles. They also give you a better understanding of these muscles and teach you how to relax them while giving birth.
  • Labour in water: Midwives advocate laboring in warm water because it is believed to help relax the perineum before the 2nd stage of birthing.
  • Squatting birth: A squatting birth may be something to look further into as you create your birthing plan. Implementing the right techniques as well as learning about the position might work for you. Always inform your doctor or midwife about your interest.
  • Find a midwife or doctor who practices non-intervention: Midwives believe in the mama’s body to safely give birth without an episiotomy using the best techniques and proven knowledge. If you choose a doctor, make sure she or he practices evidence based medicine and keeps your desires in mind while you’re planning your birth.

Working with your body

Our bodies are simply amazing. Although modern medicine and medical practices don’t preach this ideology to it’s fullest extent, educating on what your body is capable of doing is important. Look up some information on what to expect during the pushing stage. Also, find some information on what you should do during the experience to keep your perineum intact. This way, you will gain more confidence for the big day.

Although episiotomies are usually not necessary, your provider may recommend the procedure under the most extreme circumstances. You can always ask your obstetrician about episiotomies and episiotomy repair. Also be sure to take care of your body to allow your little one to thrive in and out the womb.

Sources:

www.evidencebasedbirth.com

www.gentlebirth.org

www.midwiferytoday.com

www.obgyn.net

www.whattoexpect.com

www.mayoclinic.org

www.medicinenet.com

www.emedicine.medscape.com

www.clinicalgate.com

www.cochrane.org

www.medlineplus.gov

Featured Image: www.mamme.it

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