Overview Episiotomy: Types and benefits of episiotomy

Overview of episiotomy

An episiotomy is a surgical incision in the perineum (the area between the legs in the pelvis) that enlarges the opening of the vagina to provide ample space during labor. It is done to prevent lacerations in the perineum and rectum. An incision is made in the perineum (skin and muscle between the vaginal opening and anus) to facilitate childbirth under local anesthesia. In addition, it reduces the risk of spontaneous episiotomy and fetal trauma during labor.

What is the type of episiotomy?

There are three types of episiotomy, depending on the placement of the incision.
●● Midline (center) episiotomy: A vertical incision is made from the center of the vaginal opening to the anus.
●● Medial and lateral episiotomy: The incision is directed to the center of the vaginal opening, which extends to the buttocks at a 45 degree angle. It also reduces the risk of tearing the muscles of the anus.
●● Outer episiotomy: It is rarely done because of the risk of damaging the underlying muscles. The incision begins 1 cm from the forchette area.

What were the possible benefits of an episiotomy?

The main purpose of an episiotomy is to prevent multiple irregular muscle tears that can occur if you press too hard or too hard. An episiotomy is most commonly performed on the first pregnancy, where the perineum is less elastic and cannot be extended, rather than on the second and subsequent pregnancies. The episiotomy was thought of as follows.
● You can prevent incontinence (the movement of the intestines and urine cannot be controlled).
● Protects the pelvic area.
● Reduces the risk of trauma to children.

What are the situations in which an episiotomy is absolutely necessary?

A low fetal heart rate stresses the baby and requires an urgent delivery. Fetal distress is a condition in which a baby’s heart rate is too fast or too slow. This leads to a reduced oxygen supply to the baby and can cause complications. To prevent this, an episiotomy is performed. However, other conditions include:
● The baby is big.
● If forceps delivery is required, an episiotomy may be performed to make room.
● Possibility of perineal laceration.
● Short perineum.
● Shoulder dystocia (when one or both shoulders of the baby get stuck).

Is an episiotomy absolutely necessary for all pregnancies?

After evaluating many reports and cases, it can be concluded that the incidence of episiotomy varies widely and that the decision to make it is usually relevant to the actual clinical situation. Experienced obstetricians can make phone calls based on the needs of the patient. Not required for all deliveries.

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What are the complications of episiotomy?

●● Bleeding and infection: Episiotomy infections are acute or chronic infections that cause necrotizing fasciitis or muscle necrosis. Acute infections may include only the skin and subcutaneous tissue. The signs are edema and exudation at the incision point. Necrotizing fasciitis can cause edema, erythema, blue or brown skin, and gangrene (tissue death). If the bleeding does not stop completely during the recovery period, it can lead to hematomas.
●● Episiotomy: When associated with episiotomy, the incidence of sphincter injury is significantly increased. Subsequent pregnancies also increase the likelihood of obstetric lacerations.
●● Urinary incontinence: Damage to the pelvic floor can pose a risk of urinary incontinence.
●● Rectal incontinence: Frequent incontinence of flatulence (gas discharge) is common.
●● Dyspareunia and sexual dysfunction: Dyspareunia (painful sexual intercourse) and sexual dysfunction are common side effects after an episiotomy.

When do you see a doctor after an episiotomy?

Discomfort and pain are gradually relieved. If you develop a fever, pustular wound, abnormal secretions from the wound, or urinary incontinence, it may be a sign of infection and it is advisable to contact your doctor immediately.

How to avoid an episiotomy?

Here are some techniques you can try to increase the elasticity of the perineum and reduce the need for an episiotomy:
● Perineal massage during the last few weeks of pregnancy has been shown to increase perineal elasticity. You should check with your healthcare provider before starting a perineal massage.
● In addition to the above, practice specific breathing exercises and pelvic floor muscle exercises.
● Kegel exercises are one of the religious exercises you must do during pregnancy. Make Kegel exercises part of your routine. It can facilitate labor and postnatal recovery. Kegel exercises strengthen the muscles of the pelvis, make labor and delivery more comfortable, and significantly reduce pain. To do Kegel exercises, squeeze and hold the muscles of the vagina and stop the flow of urine for about 10 seconds. Repeat this several times during the day.
● During labor, you can continue a perineal massage with warm vaginal compression to relax the vaginal muscles.
● You can also try different labor positions. Kneeling on all fours allows you to relax and give birth without an episiotomy. Some deep crouching postures can increase the likelihood of tearing.


The need for an episiotomy depends on your clinical situation. But don’t hesitate to discuss the risks associated with an episiotomy with your doctor. Make sure you have cleared all your questions and overcame your work with an open and calm mind.

Frequently Asked Questions (FAQ)

  1. How long does it take for the episiotomy stitch to heal?
    Complete wound healing takes about a month after birth. The pain lasts about 2-3 weeks, but it takes several months for the seams to disappear completely.
  2. How can I heal faster after an episiotomy?
    a. After giving birth, take a warm water bath to increase circulation and reduce pain. Also, apply ice to the area to prevent swelling.
    b. Kegel exercises are one of the exercises that prevent an episiotomy and help heal after an episiotomy. Kegel increases circulation, reduces swelling and aids healing. Kegel strengthens the perineal muscles like a hammock.
    c. Take prescription medications or over-the-counter painkillers and stool softeners.
  3. Do I need an episiotomy for subsequent pregnancies?
    In most cases, it is not necessary to repeat the episiotomy, but it depends on the clinical situation of the next pregnancy. We will consider it according to the needs and needs at the time of delivery. Some women may have scars from their previous pregnancy, which does not grow. After that, you may need to repeat the episiotomy.

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