Episiotomy: Healing after childbirth

When is an episiotomy performed?

An episiotomy is performed much less frequently today than it was a few years ago. In the past, it was often preferred to tearing the dam . Today it is better to allow a tear because it is assumed that a natural tear heals better in the weakest parts of the perineum and is more gentle on the surrounding muscles and vessels. Nevertheless, there are cases in which an episiotomy is still necessary and helpful:

• The episiotomy is performed when the birth process is unnaturally prolonged and your baby is no longer feeling well. Then the expulsion phase can be shortened with an episiotomy and the birth can be ended more quickly.
• To protect against a serious perineal tear, an episiotomy is still performed.
• In the case of a breech birth and births with forceps , an episiotomy may be necessary. In the case of ventouse births , on the other hand, it is usually not necessary.

what is the dam

How is an episiotomy performed?

The perineum is incised at the peak of a contraction, when the tissue is very stretched and at its most insensitive to pain. Depending on the situation, the incision is made in the middle (median episiotomy) or from the midline to the side (mediolateral episiotomy). The incision can be two to eight centimeters long. The median incision heals better but is associated with a higher risk of injury to the sphincter. The mediolateral incision is chosen when more space is required during delivery.

How is an episiotomy treated in the delivery room?

After a local anesthetic, the incision is carefully sewn up. Not only the depth and length of the incision is crucial for wound healing, but also the suturing technique. However, the supply is not urgent. First you can get to know your baby and put it to your breast for the first time.

Healing of the episiotomy in childbed

The episiotomy can cause pain, swelling, infection, and sometimes bleeding. Most women don’t feel this pain until several hours after giving birth because the body is too exhausted to feel it beforehand. Lying down, running, everyday movements, spreading your legs can hurt you in the time after the birth and should be avoided as far as possible. Bowel movements can also be painful. Many women are unable or unwilling to go to the toilet for a while. This can also have consequences for digestion. Therefore, wound healing should be supported with the following measures:

• To clean the wound and promote the healing process, short sitz baths with healing salts and essential oils or rinsing off with clear water are recommended. However, the area should then be thoroughly dried by gently patting the perineum with a drying cloth or gently drying it with a hair dryer.
• You should also change your maternity pads frequently, otherwise they can cause infections.
• Ice or special compresses are used for cooling in order to promote blood circulation and allow swelling to subside. Some midwives even recommend breast milk compresses.
• Regular seam checks are also important in order to be able to detect and prevent inflammation early on. In a few cases, anti-inflammatory drugs are used. Medicinal infection prophylaxis is rarely recommended.

Episiotomy less common in modern clinics

If the birth process is not unnaturally long and difficult for your child and you are not planning a risky birth, then midwives advise against a precautionary episiotomy. If the perineum is about to rupture, then it is a natural injury – the weak spots in the tissue are the first to rupture. In episiotomy, on the other hand, strong vessels and solid tissue are often severed. This creates unnecessary bruising, delaying normal healing and causing additional wound pain. In the case of an episiotomy, suturing the incision is essential. Unfortunately, the threads are often regarded as foreign bodies by your body and thus lead to additional inflammation. Many women are therefore worse off after a cut than after a perineal tear.

It is therefore advisable to pay attention to the episiotomy rate when selecting the clinic. Does the clinic perform more episiotomy than others? Then this is not a good sign. Be sure to ask about the reasons for the high rate. Because it often provides information about the attitude and training of hospital staff on the subject of perineal protection and perineal tears.

How can you prevent an episiotomy?

A perineal massage should be part of your birth preparation so that the perineum does not have to be incised during birth and, ideally, a perineal tear does not occur. But even during birth, the so-called “dam protection” tries to protect the dam as much as possible. You can learn more about perineal protection in our article “ When a perineal tear occurs ”.