Giving birth cut

Episiotomy | Johns Hopkins Medicine

What is an episiotomy?

An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.

Normally, once the baby's head is seen, your healthcare provider will ease your baby's head and chin out of your vagina. Once the baby's head is out, the shoulders and the rest of the body follow.

Sometimes the vaginal opening does not stretch enough for the baby's head. In this case, an episiotomy aids your healthcare provider in delivering your baby. It's important to make a surgical incision rather than letting the tissue tear. Your provider will usually do an episiotomy when the baby's head has stretched your vaginal opening to several centimeters.

Once you deliver the placenta, your healthcare provider will stitch the cut. If you don't have an epidural, your provider may inject a numbing medicine into the perineum. This will numb it before the provider repairs the episiotomy.

Why might I need an episiotomy?

Not all women need an episiotomy. Stretching the tissues naturally may help reduce your need for it. Ask your healthcare provider about how to do this on your own. Without an episiotomy, your perineal tissues may tear. This can be harder to repair.

Your provider may advise an episiotomy in these situations:

The baby does not have enough oxygen (fetal distress)
Complicated birth, such as when the baby is positioned bottom or feet first (breech) or when the baby's shoulders are trapped (shoulder dystocia)
Long pushing stage of labor
Forceps or vacuum delivery
Large baby
Preterm baby

Your healthcare provider may have other reasons to recommend an episiotomy.

What are the risks of an episiotomy?

Some possible complications of an episiotomy may include:

Bleeding
Tearing into the rectal tissues and anal sphincter muscle which controls the passing of stool
Swelling
Infection
Collection of blood in the perineal tissues
Pain during sex

You may have other risks based on your condition. Be sure to discuss any concerns with your healthcare provider before the delivery.

How do I get ready for an episiotomy?

Your healthcare provider will explain the procedure and you can ask questions.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. The form may be part of the general consent for your delivery.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia.
Tell your healthcare provider of all medicines (prescribed and over-the-counter), vitamins, herbs, and supplements that you are taking.
Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before labor.
Follow any other instructions your provider gives you to get ready.

What happens during an episiotomy?

Your healthcare provider may do an episiotomy as part of your vaginal birth. The procedure and the type of episiotomy may vary based on your condition and your healthcare provider's practices.

Generally, an episiotomy follows this process:

You will lie on a labor bed, with your feet and legs supported for the birth.
If you have not been given any anesthesia, your provider will inject a local anesthetic into the perineal skin and muscle. This will numb the tissues before the incision is made. If epidural anesthesia is used, you will have no feeling from your waist down. In this case, you won't need more anesthesia for the episiotomy.
During the second stage of labor (pushing stage), as your baby's head stretches your vaginal opening, your healthcare provider will use surgical scissors or a scalpel to make the episiotomy incision
Your provider will deliver your baby followed by the placenta.
He or she will check the incision for any further tearing.
Your provider will use stitches (sutures) to repair the perineal tissues and muscle. The stitches will dissolve over time.

What happens after an episiotomy?

After an episiotomy, you may have pain at the incision site. An ice pack may help reduce swelling and pain. Warm or cold shallow baths (sitz baths) may ease soreness and speed healing. Medicated creams or local numbing sprays may also be helpful.

You may take a pain reliever as recommended by your doctor. Be sure to take only recommended medicines.

Keep the incision clean and dry using the method your healthcare provider recommends. This is important after urination and bowel movements. If bowel movements are painful, stool softeners recommended by your healthcare provider may be helpful.

Do not douche, use tampons, or have sex until your healthcare provider says it's OK. You may also have other limits on your activity, including no strenuous activity or heavy lifting.

You may go back to your normal diet unless your healthcare provider tells you otherwise.

Your healthcare provider will tell you when to return for further treatment or care.

Tell your healthcare provider if you have any of the following:

Bleeding from the episiotomy site
Foul-smelling vaginal drainage
Fever or chills
Severe perineal pain

Your healthcare provider may give you other instructions after the procedure, based on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person's qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure

Episiotomy and perineal tears - NHS

Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.

An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.

Sometimes a woman's perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.

If your doctor or midwife feels you need an episiotomy when you're in labour, they will discuss this with you. In England, episiotomies are not done routinely.

Non-urgent advice: Call your midwife or GP if you've had an episiotomy or tear and:

your stitches get more painful
there's smelly discharge
there's red, swollen skin around the cut (incision) or tear – you can use a mirror to have a look

Any of these may mean you have an infection.

Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.

The National Institute for Health and Care Excellence (NICE) recommends that an episiotomy might be done if:

the baby is in distress and needs to be born quickly, or
there is a need for forceps or vacuum (ventouse), or
there is a risk of a tear to the anus

Around 1 in 7 deliveries in England involves an episiotomy.

If you have a tear or an episiotomy, you'll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.

Why you might need an episiotomy

An episiotomy may be recommended if your baby develops a condition known as foetal distress, where the baby's heart rate gets faster or slower before birth.

This means your baby may not be getting enough oxygen and has to be delivered quickly to avoid the risk of birth injuries or stillbirth.

Another reason for an episiotomy is because it's necessary to widen your vagina so instruments, such as forceps or ventouse suction, can be used to help with the birth.

This may be necessary if:

you're having a breech birth, where the baby is being born with their bottom or feet first
you have been trying to give birth for several hours and are now tired after pushing
you have a serious health condition, such as heart disease and it's recommended that delivery should be as quick as possible to reduce further health risks

Research shows that in some births, particularly with forceps deliveries, an episiotomy may prevent tears that affect the anal muscle (third-degree tears).

How an episiotomy is done

An episiotomy is usually a simple procedure. A local anaesthetic is used to numb the area around the vagina so you do not feel any pain. If you have already had an epidural, the dose can be topped up before the cut is made.

Whenever possible, the doctor or midwife will make a small diagonal cut from the back of the vagina, directed down and out to one side. The cut is stitched together using dissolvable stitches after the birth.

Recovering from an episiotomy

Episiotomy cuts are usually repaired within an hour of your baby's birth. The cut may bleed quite a lot at first, but this should stop with pressure and stitches.

Stitches should heal within 1 month of the birth. Talk to your midwife or obstetrician about which activities you should avoid during the healing period.

Coping with pain

It's common to feel some pain after an episiotomy.

Painkillers such as paracetamol can help relieve pain and is safe to use if you're breastfeeding.

It's also thought to be safe to take ibuprofen while you're breastfeeding, but check with your doctor first.

Aspirin is not recommended as it can be passed on to your baby through your breast milk. Your midwife will advise you if you're not sure what painkillers to take.

It may be necessary to treat severe pain with stronger prescription-only painkillers, such as codeine.

However, prescription-only medicine may affect your ability to breastfeed safely. Your GP or midwife can advise you about this.

To ease the pain, try:

placing an ice pack or ice cubes wrapped in a towel on the cut. Avoid placing ice directly on your skin as this could cause damage

Exposing the stitches to fresh air can help the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help.

It's unusual for pain after an episiotomy to last longer than 2 to 3 weeks. If the pain lasts longer than this, speak to a doctor, health visitor, or another health professional.

Going to the toilet

Keep the cut and the surrounding area clean to prevent infection. After going to the toilet, pour warm water over your vaginal area to rinse it.

Pouring warm water over the outer area of your vagina as you pee may also help ease the discomfort.

You may find squatting over the toilet, rather than sitting on it, reduces the stinging sensation when peeing.

When you're pooing, you may find it useful to place a clean pad on the cut and press gently. This can help relieve pressure on the cut.

When wiping your bottom, make sure you wipe gently from front to back. This will help prevent bacteria in your anus infecting the cut and surrounding tissue.

If you find pooing is particularly painful, taking laxatives may help. This type of medicine is usually used to treat constipation and makes poo softer and easier to pass.

For more information, read about treating constipation.

Pain during sex

There are no rules about when to start having sex again after you've given birth.

In the weeks after giving birth, many women feel sore as well as tired, whether they've had an episiotomy or not. Do not rush into it. If sex hurts, it will not be pleasurable.

If you've had a tear or an episiotomy, pain during sex is very common in the first few months.

If penetration is painful, say so. If you pretend everything is OK when it is not, you may start to see sex as a nuisance rather than a pleasure, which will not help you or your partner.

You can still be close without having penetration – for example, through mutual masturbation.

Pain can sometimes be linked to vaginal dryness. You can try using a water-based lubricant available from pharmacies to help.

Do not use an oil-based lubricant, such as Vaseline or moisturising lotion, as this can irritate the vagina and damage latex condoms or diaphragms.

You can get pregnant just 3 weeks after the birth of a baby, even if you're breastfeeding and your periods have not started again.

Use some kind of contraception every time you have sex after giving birth, including the first time (unless you want to get pregnant again).

You'll usually have an opportunity to discuss your contraceptive options before you leave hospital (if you've had your baby in hospital) and at the postnatal check.

You can also talk to a GP, midwife or health visitor, or go to a contraception clinic at any time.

Find sexual health services near you.

Infection

Look out for any signs that the cut or surrounding tissue has become infected, such as:

red, swollen skin
discharge of pus or liquid from the cut
persistent pain
an unusual smell

Tell a GP, midwife or health visitor as soon as you can about any possible signs of infection so they can make sure you get the treatment you might need.

Exercises

Strengthening the muscles around the vagina and anus by doing pelvic floor exercises can help with healing and will reduce the pressure on the cut and surrounding tissue.

Pelvic floor exercises involve squeezing the muscles around your vagina and anus as though to stop yourself from going to the toilet or farting.

A midwife can explain how to do the exercises. You can also read more about pelvic floor exercises on our page about exercise in pregnancy.

Scar tissue

For a few women, excessive, raised or itchy scar tissue forms around the place where a tear happened or where an episiotomy was done. If your scar tissue is causing problems for you, tell your doctor.

Preventing a perineal tear

A midwife can help you avoid a tear during labour when the baby's head becomes visible.

The midwife will ask you to stop pushing and to pant or puff a couple of quick short breaths, blowing out through your mouth.

This is so your baby's head can emerge slowly and gently, giving the skin and muscles of the perineum time to stretch without tearing.

The skin of the perineum usually stretches well, but it may tear, especially in women who are giving birth for the first time.

Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during birth.

The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.

The most benefit was in women who repeated this every day.

How to behave in childbirth? Learning to give birth quickly and with problems

Childbirth is a natural process, laid down by nature. The whole sequence of events that take place during this period is predetermined, but by your actions you can either speed up the birth of a baby, or complicate his birth.

Childbirth is the final and most important stage of pregnancy. How you behave and how accurately and skillfully you follow the instructions of the obstetrician depends on how you will feel and how quickly your baby will be born. What does a newborn need to know? Let's try to answer the most important questions.

1. When is it time to go to the maternity hospital?

Childbirth is a natural result of hormonal changes that occur in your body during the final stages of pregnancy. The sagging belly and heaviness in its lower part and the lumbar region speak of the imminent denouement of the story. Periodically, weak contractions occur, the stomach tenses and pulls down, but these sensations quickly pass, the uterus relaxes again and becomes soft. Such contractions are harbingers of childbirth, but they are far from real labor activity.

The signal to call an ambulance should be sufficiently strong contractions that are repeated at regular intervals, the appearance of mucous secretions from the genital tract, slightly stained with blood, or the outflow of amniotic fluid.

2. First stage of childbirth: we breathe for two!

From the moment the contractions become regular, the first stage of labor begins, during which the strength, frequency and duration of uterine spasms increases and the cervix opens.

During spastic contraction of the uterine muscle fibers, the blood vessels that carry arterial blood to the placenta and fetus are compressed. The fetus begins to experience a lack of oxygen, and this involuntarily makes you breathe deeper. The reflex increase in the rate of contractions of your heart will ensure the delivery of oxygen to the child. Nature has provided that these processes take place regardless of your consciousness, but you should not completely rely on it.

In the first stage of labor, during each contraction, you need to breathe calmly and deeply, trying not to hold your breath while inhaling. At the same time, the air should fill the upper sections of the lungs, as if raising the chest. You need to inhale through the nose, slowly and smoothly, exhale through the mouth, just as evenly.

3. Auto-training in the prenatal ward

To speed up the opening of the cervix, you need to walk more, but sitting is not recommended, while blood flow in the limbs is disturbed and venous blood stagnation occurs in the pelvis. From time to time it is useful to lie on your side, stroking your lower abdomen with both hands in the direction from the center to the sides, focusing on breathing and saying to yourself: "I am calm, I am in control of the situation, each contraction brings me closer to the birth of a baby."

4. To relieve pain

Acupressure of the lower back can help relieve pain. Find the outer corners of the sacral rhombus on your lower back and massage these points with clenched fists.

Monitor the frequency and duration of contractions and if they weaken or sharply increase, immediately inform your doctor. In case of severe pain, you can ask for an anesthetic, but you should remember that you should not take the medicine too often, this is fraught with narcotic depression of the newborn and a decrease in his adaptive abilities.

If dilatation of the cervix causes reflex vomiting, rinse the mouth with water and then drink a few sips to replace the lost fluid. Do not drink a lot, this can provoke a recurrence of vomiting.

5. The maternity ward is not a place for tantrums

They say that difficult childbirth is a person's retribution for walking upright. Childbirth is actually a painful process, but the presence of reason allows us, representatives of the genus Homo sapiens, to control our emotions. Screaming, crying, tantrums and swearing have no place in the maternity ward. This creates a tense environment, interferes with the normal course of childbirth, complicates diagnostic and therapeutic measures, and ultimately affects their outcome.

6. Second stage of labor - pushing and expulsion of the fetus

After the baby's head slips through the dilated cervix and finds itself on the bottom of the pelvis, the pushing period of labor begins. At this time, there is a desire to push, as it usually happens during a bowel movement, but at the same time many times stronger. At first, the attempts are controllable, they can be "breathed", but by the beginning of the third stage of labor, the expulsion of the fetus, they become unbearable.

With the beginning of the straining period, you will be transferred to the delivery room. Having settled down on the delivery table, rest your feet on the special steps, firmly grasp the handrails and wait for the midwife's command.

While pushing, inhale deeply, close your mouth, clench your lips tightly, pull the handrails of the delivery table towards you and direct all the exhalation energy down, squeezing the fetus out of you. When the top of the baby appears from the genital slit, the midwife will ask you to ease your efforts. With gentle movements of her hands, she will first release the baby’s forehead, then his face and chin, after which she will ask you to push again. At the moment of the next attempt, the baby's shoulders and torso will be born. After the newborn is born, you can breathe freely and rest a little, but the birth is not over.

7. Third stage of labor and final

Third stage of labor - afterbirth. At this time, weak contractions are observed, due to which the fetal membranes gradually exfoliate from the walls of the uterus.

About 10 minutes after your baby is born, your midwife will ask you to push again to deliver your afterbirth. The doctor will carefully examine it and make sure that all parts of the membranes have come out. After that, with the help of mirrors, he will examine the cervix and make sure that it is intact. If necessary, all tears will be closed with absorbable sutures.

You will have to spend another couple of hours in the delivery room with an ice-filled bladder on your stomach. To quickly contract the uterus, you will be given injections of special drugs. When the threat of postpartum hemorrhage has passed, you will be transferred to the postpartum ward to the baby.

Childbirth completed. Ahead of the postpartum period, during which your body will recover after pregnancy.
More details on Medkrug.RU: http://www.medkrug.ru/article/show/kak_pravilno_vesti_sebja_v_rodah_uchimsja_rozhat_bystro_i_problem

Source: http://www.medkrug.ru/

So, if you have contractions or amniotic fluid has poured out, go urgently to the hospital.

In the admission department of the maternity hospital, you will be met by the midwife on duty, who will complete the necessary documents, measure blood pressure, body temperature, pelvic dimensions, and listen to the fetal heartbeat.

Sanitization: shaving of pubic hair and cleansing enema is carried out only at your request.

In the admission department, a doctor will examine you, perform an ultrasound scan, and then you will be taken to the maternity ward.

If you were admitted to the maternity hospital not fully examined or you have any infectious disease (ARVI, influenza, kidney disease, lung disease, etc.), i.e. there is a possibility of pregnancy complications and a threat to the fetus and mother, you will be hospitalized in a specialized obstetric observational department, where highly qualified specialists successfully treat and safely deliver high-risk women, minimizing the adverse effects of infection on the mother and fetus.

The obstetric observation department is a mini-maternity hospital in a maternity hospital, equipped with all the necessary equipment for high-quality and most favorable delivery and management of the postpartum period.

The observational obstetric department is isolated from other departments and premises of the maternity hospital.

Conducting and receiving childbirth in the maternity hospital around the clock is carried out by a team of highly qualified specialists with many years of experience, consisting of 8 doctors: 4 obstetrician-gynecologists, 2 anesthesiologists, a neonatologist, a neonatologist-resuscitator. In the maternity block, midwives are constantly on duty, who are personally responsible for the woman in labor.

Childbirth is taken on a special bed in the position of a woman on her back with her legs bent and spread apart or in a vertical position (in the absence of contraindications - varicose veins of the lower extremities, external genital organs, elephantiasis) - which provide for the free behavior of a woman in childbirth, the possibility of taking soul, holding the second stage of labor in a “vertical position”, which allows the baby to be born independently, atraumatically, more physiologically.

After birth, the baby is placed on the mother's stomach and applied to the breast. Mom has the opportunity to take the child in her arms in the first minutes of life. The umbilical cord is crossed after the cessation of pulsation.

In the delivery room, in order to prevent gonoblenorrhea, a solution of albucid is instilled into the conjunctival sac of the newborn (eyes) and the genital slit (for girls).

After childbirth, washing the newborn under a tap with water, as it was before, is not performed. Removal of the original lubricant is not performed.

In order to prevent infectious and inflammatory skin diseases in newborns during the first three days of life, skin folds are treated once a day with a 0.5% solution of chlorhexidine.

Within two hours after the birth, the mother and child are in their birth box, then they are transferred to the postpartum ward.

It is important for a woman in childbirth to conduct the so-called "partner birth", when a husband or close relative is present throughout the birth, creating psycho-emotional comfort and a sense of "home environment".