Episiotomy, and if you discussed it before?
What is episiotomy? Is it unavoidable, painful? Does it prevent tearing, incontinence? The responses of two midwives.
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What is Episiotomy?
- The episiotomy is an incision of the perineum (a set of muscles supporting the genitals, from the vulva to the anus) during childbirth, to allow the passage of your baby. At this time, the perineum is stretched to the maximum. The midwife, or the gynecologist, introduces a branch of the surgical scissors into the vagina and usually performs a “mid-lateral” episiotomy to the right or the left with an angle of 45 degrees To the horizontal.
- This incision measures 3 to 4 cm. It is suture carried out immediately after delivery, under local anesthesia or the effect of the epidural. It is performed with absorbable yarns. The vaginal wall is re-sewn, then the levator muscle of the anus (the one that is contracted when you want to refrain from peeing) and finally the skin of the perineum. The threads will dissolve in two to three weeks, sometimes a little more.
In which cases is it recommended?
- For years, obstetricians and midwives learned that episiotomy should be used almost systematically for first birth, to give birth to large babies, when using instruments to extract the baby ( Forceps, suction cup ), in the case of an epidural, under the pretext that the mother can not grow well, or when the child is suffering fetal. However, no studies have proved the value of systematic episiotomy in all these cases.
- Since 2005, obstetricians and midwives are advised to avoid it as much as possible. The only case where the episiotomy is indicated systematically is when the space between the anus and the opening of the vagina is short, i.e., less than 3 cm. During prenatal consultations, the obstetric gynecologist, or midwife, who follows you, can check with the naked eye if this is the case.
Does episiotomy prevent a tear?
For a long time, it was thought better to have an episiotomy than a tear in the perineum. However, the studies confirm this: the episiotomy does not avoid it in any way. On the contrary, it may even be the door open to a more severe laceration in the prolongation of the incision. Also, the tears of the perineum without episiotomy are very often less important and superficial.
Does it protect against further incontinence?
Concerning urinary and anal incontinence, a study was conducted in two French university maternity wards with different episiotomy policies: as little as possible for one and systematic for the other. The result shows that women who gave birth in the maternity ward where we practice the narrow episiotomy have four years after birth, half of anal incontinence than women who had their child in the other motherhood. The study concludes that systemic episiotomy does not protect against urinary or anal incontinence four years after childbirth.
Can we refuse an episiotomy?
- In theory, yes. The law of 4 March 2002 ** prohibits the practice of a medical procedure on a person who has not given his consent.
- Before reaching this point, if you are reluctant to episiotomy, try to choose, as far as possible, a maternity that does little to practice it. For this, ask for the rate of episiotomy practiced at the year, a figure that each maternity must be able to provide you. There are wide variations between regions, hospitals and different professionals.
- Once you have chosen your maternity, specify several times during prenatal consultations that you do not want an episiotomy. Also, ask for your reluctance on your file.
- On the day of delivery, remind the medical team again of your desire to avoid it. However, do it at work, not at the time of expulsion!
Is there a greater likelihood of having an episiotomy for a first child?
Unfortunately yes. However, if you have an episiotomy for a first child, it does not mean you have one for a second or third child. Every delivery is different. It is only when the child’s head appears that the gynecologist, or the midwife, can assess how the perineum reacts. However, there is no indication that an episiotomy is still the only possible choice. It is demonstrated that a tear is less painful and bleeds less than an episiotomy in direct sequels. Moreover, in the longer term, no benefit has been shown in favor of episiotomy for a first child.
At what point in pregnancy ask for more information about episiotomy?
Discuss the issue of episiotomy yourself when preparing for delivery if the midwife does not. You will be less anxious on D-Day. Also, talk to the obstetrician or midwife who is following your pregnancy and do not wait until the last moment to ask for information. Also ask about care after an episiotomy, even if you do not know if you will have one.
What care is involved in this intervention?
- During the stay at the maternity, you will be asked to use a particular soap for your intimate hygiene. No need for antiseptics, they were particularly necessary in the case of infection. In most maternity hospitals, regular care is no longer carried out by the medical team. On the other hand, the teams insist on the education of the young mothers to the care consecutive to the episiotomy.
- They consist of cleaning the perineum and the scar with the soap, to rinse and to dry by dabbing gently with a clean towel.
- The practice of using the heat of a hair dryer to accelerate the healing has been abandoned because the heated air does not bring anything. It may even potentiate the risk of bacterial proliferation.
- It is best to dry in the open and dab with a clean towel as well as change trim several times a day to keep the scar environment clean. Midwives stress the importance of this intimate hygiene, an essential condition for real healing.
- In the absence of infection, the perineum heals in about two weeks. If the area remains sensitive longer, you can massage it with a product recommended by your doctor, or your midwife, to soften it. Finally, when you go to the toilet, wipe from the front to the back to avoid contamination by fecal germs. Moreover, most importantly, ask your maternity staff about the care you will have to do yourself back home.
How long do the painful sensations last?
- The immediate consequences of the episiotomy are often very sensitive for a few days. It is also possible that the wires of the scar “pull” and cause a sensation of discomfort. Although it has often been advisable to sit on a buoy, it has been found that its use favors the descent of the organ. Choose a large comfortable cushion.
- Before leaving the maternity ward, do not hesitate to talk about your pain so that you are prescribed medication if needed. In the case of persistent pain, paracetamol has little effect, but non-steroidal anti-inflammatory drugs are effective. If you breastfeed, you will be prescribed analgesics compatible with breastfeeding.
- Do not worry; it is not because you are breastfeeding that any medication is prohibited. For example, a combination of paracetamol and ibuprofen may be considered. However, no self-medication. Take the advice of the doctor first. If the pain persists beyond three weeks, check again.
What are the possible complications?
- The infection and disunion of the scar, or both. These complications occur a few days after the delivery and are felt by an embarrassment and pain. Bleeding is not necessarily accompanied by disunion, and infection is recognized by smelly losses. When in doubt, observe your scar in a mirror. You will see if one or more wires have dropped. In this case, you should consult your obstetrician. He will prescribe you local care with antiseptics to be practiced several times a day so that healing is done naturally, without having to intervene.
- Persistent pain can also be caused by a hematoma that you can still see with a mirror. Nothing to worry though. The only thing to do is to check that it does not extend. In principle, the hematomas naturally resolve after a few days to a few weeks.
- Sometimes a thread gets into the scar and causes a small ball. Again, there is nothing special to do, if not wait. It will eventually disappear, but it may take a few weeks.
How long to wait after the episiotomy before finding sex without discomfort?
- It is impossible to give a definite time frame. Even without episiotomy, the resumption of sexual intercourse after childbirth is not clear. The fatigue, your apprehension, that of the dad who asks many questions, the couple who discovers their parents … That is why it is so important to approach the issue by dialogue.
- After an episiotomy, it is possible that during sexual intercourse, you feel that your vagina is narrower as if you were sewn “tighter.” This is due to the healing process: initially, all fibers heal, except elastic fibers for which it is necessary to wait several months. In the meantime, they are much less supply, hence this feeling of the narrowness of your vagina.
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