During the delivery of a baby, some women will require an episiotomy. An episiotomy occurs when the doctor takes a sterile pair of scissors and makes an incision in the tissue between the vagina and anus (the perineum).
Having an episiotomy was once considered to be a routine part of childbirth because doctors thought that a woman would heal faster from being cut than tearing naturally. With research and testing, doctors have now found that an episiotomy does not usually offer any great benefits. However, there are times that an episiotomy is still necessary during childbirth. Doctors will perform an episiotomy to make the vaginal opening larger if your baby needs to be delivered quickly. Doing so could prevent your baby from being stuck in the birth canal and suffering from oxygen deprivation. Your doctor may also perform an episiotomy if he feels that your vaginal tissues will tear extensively. A large vaginal tear may be more painful and take longer to heal than a simple episiotomy in this case.
An episiotomy is done in your labor/delivery room and is performed by your doctor. Your obstetrician will use a sterile pair of scissors to careful snip the perineum. If you have not had an epidural or pain medications, you will receive a local anestethic to numb the area to be cut. However, because of the pressure of the baby's head, you will not feel the cut anyways.
You can help soften the tissues in the vagina and perineum during the last few weeks of pregnancy by having perineal massage. Although the massage will not guarantee against tearing or needing an episiotomy, it may help to reduce the chances. You simply wash your hands well with soap and water. Using a lubricant, place your thumbs inside of the vagina and rub downwards towards the rectum. You should do this for 5-10 minutes each day. Your spouse or labor partner can help with the massage as well.
Healing from a vaginal tear or episiotomy takes some time. The perineum will be very sore for a few days to a few weeks after delivery, depending on the severity. Episiotomies generally hurt worse when you are sitting, walking or using the bathroom. It is critical that you keep the episiotomy site clean. Most hospitals will give you a squirt bottle to use for this purpose. Use an ice pack, witch hazel pads or a wound spray to help soothe the area. Take pain medications if needed and prescribed by your doctor. Be aware that when you are urinating, it may burn. Some women find that squirting warm water on their vagina while they are urinating helps to ease the burning sensation. Finally, take your time. Sit down carefully and walk slowly. Call your doctor if the wound becomes extremely painful, red, hot, swollen or has a foul odor or discharge.
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