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Episiotomy
An episiotomy is a surgical cut, done to enlarge the entrance to
the vagina, when it is clear that the mother and baby are tiring
from a long, difficult second stage labour. This may indicate that
the woman's vaginal opening will not stretch wide enough to
accommodate the baby's head, thus needing to be enlarged. In the
case of the baby being born pre-term, an episiotomy may also be
performed to protect the delicate head, so allowing for an easier
birth with less complication.
An episiotomy is usually done during a contraction, where the baby's
head has already distended the perineum, causing a numbed effect - a
local anaesthetic can also be administered if you feel the need.
Without an episiotomy, many of the women experiencing a long labour,
run the risk of tearing the skin and surrounding muscles. Some do
report however, that a tear is far less painful and is faster
healing than an episiotomy, and it is probably for this reason and
others that episiotomies are no longer done as routine in most
hospitals.
Avoiding an episiotomy
It is usually possible to avoid having to undergo an episiotomy,
however there are times when it may be absolutely necessary to
perform one, as in the case of complications arising.
You can assert your right to choose whether or not to have an
episiotomy, by preparing yourself well in advance:
Perineal massage:
The perineum, is the area between the vaginal opening and the anus,
and during childbirth, this area endures the most pressure, by
stretching to accommodate the birth of your baby's head.
Daily massaging of your perineum with a suitable oil for at least
six weeks prior to the birth, will help it to become more supple,
thus coping with the added strain.
It is very important that, your hands be clean, and if you
experience any pain or develop a vaginal infection that you
discontinue with the perineal massaging.
Pelvic floor exercises:
The pelvic floor is made up of a group of muscles, that support your
uterus, bladder and bowel. Exercising these muscles during
pregnancy, will help tone them up, thus allowing for better support
to your growing baby and enlarging uterus, and will also allow for
you to fully relax your pelvic floor whilst giving birth. These
exercises can be done at any time of the day or night, and by
practicing them after the birth you will also be reducing your
chances of developing stress incontinence, a prolapsed uterus and
will definitely increase both you and your partners sexual
satisfaction.
- Sit in a comfortable position with your legs slightly
separated, or lie on your back with your knees bent and arms
relaxed at your sides.
- Tense the muscles around the urethra as if to cease the flow
of urination, hold for a count of three, then relax completely.
- When doing this exercise correctly, you should notice how your
buttock muscles tense, and your knees draw slightly inwards.
- The rest of your body should remain in a total relaxed state,
and you shouldn't hold your breath, although this may be quite
difficult to achieve at first.
Repairing an episiotomy
Repairing an episiotomy requires stitching, and depending on the on
the depth and number of stitches required, you may find yourself,
legs in lithotomy stirrups, baring all, shortly after the birth of
your baby. As many women report, this procedure is actually worse
than the cut itself, as it is performed shortly after the birth,
when most mothers have just settled down with their babies after a
long labour. If the epidural has worn off by the time you need to be
sutured, a local anaesthetic will be administered. The internal
tears will be the first to be remedied, followed by muscle repairs,
and lastly the outer skin. The stitching will be soluble, so there
won't be any need for removal.
Perineal care for after the birth
When having had a tear or episiotomy repaired, it will be normal for
you to feel extremely tender for several days after the birth,
however there is no need to suffer in silence, and if you feel that
your stitches are still uncomfortably tight by the time you leave
the hospital, it may be wise to ask for your doctor's advice. Any
bruising that was sustained during the procedure will eventually
fade, and the scar will settle in a few days, but you can speed-up
the recovery by proper perineal care.
- Add a cupful of salt to your bathwater, or a handful to a bowl
of warm water, and sponge daily.
- When urinating, pour a jug of warm water over the area, to
prevent the burning sensation from the urine coming into contact
with the area.
- As horrendous as it sounds, exposing your perineum to fresh
air and a little daily sunshine, will aid in the healing process.
- Always be sure to dry the area well, keeping a separate, clean
towel especially for this.
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