Episiotomy

What is an Episiotomy?
An Episiotomy is the surgical procedure that involves cutting a incision in the skin from the base of the vagina down to near the rectum, this area is called Perineum. While having an Episiotomy is now not a standard procedure, there are valid reasons for getting one done. Reasons for having this procedure could be because you have a major breech or your baby is found to be distressed or if your baby is somehow inhibited to emerge from the birth canal.

The way the episiotomy is carried out is by firstly having the perineum numbed, then there is one of two ways of the incision can done.
The first way that an incision can be made is called 'Midline Incision' were as the name suggests, is a cut down the middle starting from the base of the vagina.
The second way is called the 'Mediolateral Cut' were the cut starts off from the base of the vagina and goes down off centre. The midline method is the option that is relativity easy to repair and less of a discomfort to the mother. The Mediolateral way is the method that the health professional favour as it is less likely to cause damage close to the rectum.
Health professional try to avoid an episiotomy were possible as the aftermath can be quite painful and some women experience incontinence. Research done into how the pelvic floor muscle is affected after a episiotomy have concluded that for all three groups (women that torn naturally, or surgically or not at all) had no significant difference in the strength of the pelvic floor muscles after just 120 days after giving birth.

Is an Episiotomy Very Painful?
If you could feel the pain, it would not compare with the pain of a contraction, and because you are numbed in advance of the process, you should not feel any sort of pain at all and this is the case with most women who go through this procedure. Some women even report that they feel that they are in a better state of mind shortly after giving birth compared to a natural birth.

Once the anesthetics wear off, and after you have been stitched up, you will feel pain. Here is a run down of what some of activities you can carry out to ease the pain and help towards a speedy recovery:

• Baths - taking baths with therapeutic oils such as lavender or a a bath with salts can help with pain relief
• Aerate - given yourself a period of time were you can allow for air circulation, by taking off your underwear
• Hot and cold therapy - use an ice pack or even a bag of peas on the area. Icepacks can reduce any swelling. Immerse yourself into a nice warm bath, but remember afterwards to pat yourself dry instead of rubbing on the stitches
• Walking - health professional recommend walking around as much as you can bear will hear with the healing process

The Different Thresholds of Tearing in an Episiotomy
There are four degrees of tear types in an episiotomy:

1. The first degree is a little tear around the base of the vagina and often heals quickly and usually requires no sticking
2. Second degree is when the tear penetrates through the skin but the anal sphincter muscle is not affected. There is a need for a lot of stitching going through the sphincter muscle. As you can expect, it will be no a comfortable experience
3. Third degree is when the tear goes through the sphincter muscle but the inner lining of the rectum is not affected. You would need careful stitching here
4. Fourth degree, this tear occur 1 in 100 episiotomy operations, so is not very common but still there do occur. The tear is everything like a third degree tear but the tear goes further into the rectum. Skilful stitching is a necessary. Women get a fourth degree tear when delivery is by forceps or a ventouse delivery. 

How to Avoid an Episiotomy
Some women have found that they can avoid the possibility of having  a episiotomy by given themselves a perineum massage on a frequently basis up to 2 months in advance of their due date.

How to do a Perineum Massage
First of all you should consider doing a perineum massage up to 8 weeks before your due date. Then carry out the massage in this fashion:

• Locate your perineum, its the stretchy area of skin found between the base of your vagina and close to your rectum
• Make sure that your nails are quite rounded as to avoid accidental scratching, and hour hands are clean and ready
• Apply an oil such as sweet almond oil or olive oil to the perineum
• Using your finger, starting from the base of of your vagina rub in a 'U' shape towards your rectum
• Repeat at least once every 2 days

To lower the probability of having an episiotomy is to be an upright position when in labour. Patting down the area with a warm towel can also help.

It can be a worry for some women on the thought of having an episiotomy, about the cut, how much it will hurt and how long it will take for them to recover. You should be assured that this procedure will only be performed if its absolutely necessary.
Letting nature tear your skin often results in smaller tears and those tears heal sooner.