An episiotomy is a small surgical incision made in the area between the vagina and anus during labor. This procedure widens the vaginal opening during delivery. In some cases, the vaginal opening may not be wide enough to accommodate the baby's head. A specialist doctor performs an episiotomy to assist the birth process and prevent potential tissue tears. It is a planned surgical procedure performed to make birth more comfortable and safe. During labor, the doctor makes a small incision in the perineum, between the lower vaginal opening and the anus. This incision helps the baby be born more easily and smoothly. However, in some cases, the perineum can tear naturally during the baby's delivery; this is called a perineal tear.

What are the Types of Episiotomy Incisions?

There are two main types of obstetric incisions: median (midline) and mediolateral. A median incision is a vertical incision that begins at the vaginal opening and extends toward the anus. This type of incision may have a higher risk of tearing the anal sphincter or rectum, but it is easier to perform.

Another type of incision, the mediolateral incision, is known as an angled or crosswise incision. This incision extends from the vaginal opening at a 45-degree angle. Mediolateral incisions have a lower risk of extending into the anal sphincter and rectum. However, disadvantages of this incision include difficulty repairing, increased blood loss, and increased discomfort during the healing process.

What is the Episiotomy Procedure?

This surgical procedure is usually performed with local anesthesia. If an epidural is used, additional numbing may not be necessary, as this anesthesia method obscures sensation from the waist down. However, if an epidural is not used, the doctor will inject a local anesthetic into the perineal area.

During an episiotomy, when the baby's head is placed through the vaginal opening and pushed into the perineal area, the doctor uses special obstetric scissors to make an incision. This incision is made to ensure a more comfortable and safe birth for the baby.

After the baby is born, the placenta arrives, and the doctor uses dissolvable stitches to repair the incision and muscles. These stitches don't need to be removed later because they dissolve on their own, making healing easier.

When Is Episiotomy Necessary?

It is performed during labor if there is a risk of tissue damage or tearing during delivery. This surgical procedure is performed to ensure a birth that is anatomically appropriate. It is necessary in the following situations:

• If the baby needs to be delivered urgently,
• If the mother has had a long and difficult birth process and is exhausted and dehydrated,
• In cases where the specialist doctor needs auxiliary tools such as vacuum or forceps to deliver the baby and the vagina needs to be wider for this,
• If the baby's shoulders are stuck in the mother's pelvis,
• If the baby has a larger than normal structure,
• If the pushing and delivery process has been going on for a long time and this process cannot be controlled, an incision may be necessary.

How Does the Recovery Process Progress After Episiotomy?

Healing typically takes about a month, but this can vary depending on the extent of the episiotomy. Pain and discomfort are normal for the first few weeks, and there are several home remedies to help alleviate this:

• You can use ice packs or perineal cold packs to reduce swelling and relieve pain.
• A warm bath promotes healing and can relieve temporary pain.
• You can use numbing sprays to numb the area for pain and itching.
• It may be helpful to use painkillers recommended by your specialist doctor.
• You can use a squeeze bottle to spray warm water onto the perineal area while urinating.
• When you need to sit, you can use a pillow to make yourself comfortable.

It's important to talk to your doctor or obstetrician about what to expect and what activities to avoid during your recovery. This will ensure your recovery progresses healthily and effectively.

What are the risks and side effects of episiotomy?

Postpartum can be associated with various risks and side effects. These possible complications include:

• Risk of bleeding: There may be a risk of bleeding during or after an episiotomy.
• Infection: There is a risk of infection developing at the incision site. Symptoms may include redness, swelling, fever, and pain.
• Painful sexual intercourse (dyspareunia): After episiotomy, there may be a feeling of pain during sexual intercourse.
• Injury to the anal sphincter and rectum: Injury to the anal sphincter or rectum may occur during or after an episiotomy.
• Pain in the scars: As the episiotomy incision heals, pain or discomfort may be felt in the scars.
• Urinary incontinence: In rare cases, urinary incontinence may occur after an episiotomy.
• Prolonged recovery time: In some cases, the episiotomy incision healing process can be lengthy and full recovery may take months.

These risks and side effects can vary from woman to woman, and it is important to consult a healthcare professional if any complications arise.

Is Episiotomy Necessary in Normal Birth?

An episiotomy may not always be necessary during a vaginal birth and varies depending on each woman's situation. It is typically performed to facilitate the delivery of the baby or prevent tissue tears. However, in modern obstetric practice, the necessity of an episiotomy is evaluated more carefully and is performed only in specific situations.

Experts are increasingly inclined to eliminate episiotomy as a routine procedure, as it can carry risks and discomfort during the healing process. During natural birth, it's common for labor to proceed normally and for a healthy baby to be born without an episiotomy.

However, in some cases, an episiotomy may be necessary. For example, if the baby is large, if unexpected complications arise during labor, or if the baby needs to be delivered quickly, an episiotomy may be preferred.

What Should You Do to Avoid Episiotomy?

Some precautions that can be taken to prevent episiotomy may be:

• Childbirth education: During pregnancy, it's important to learn about the birth process by attending childbirth education or preparation classes. These classes can help you learn how to relax during labor, proper breathing techniques, and birthing positions.
• Flexibility exercises: During pregnancy, exercises can be done to strengthen the pelvic floor and increase flexibility. Yoga, Pilates, or exercises that target the pelvic floor muscles can help you have a less traumatic experience during labor.
• Creating a birth plan: Creating a birth plan before birth can help you discuss your birthing options and preferences with your healthcare team. This can help your healthcare team guide your labor and delivery according to your preferences and collaborate with you if an episiotomy is necessary.
• Stretching and massage: Perineal massage and stretching exercises can be done during pregnancy to help the perineum become more flexible during labor. This can reduce the likelihood of tears requiring stitches.
• Birthing positions: Trying various positions during labor can help the baby pass through the birth canal more easily. Some positions widen the pelvic area and may reduce the risk of an episiotomy.
• Practicing natural birth: If possible, practicing natural birth is preferable. This involves not interfering with the body's natural processes and allowing the baby to come out naturally. This way, the likelihood of miscarriage can be reduced.

However, it's important to remember that every birth experience is unique, and sometimes, despite the precautions taken, an incision may be necessary. Therefore, it's important to consult your healthcare team and consider the options most suitable for you during your labor and delivery.

Which Muscles Are Cut During an Episiotomy?

During the procedure, the skin and muscle tissues in the perineal region are incised. This incision is usually made in the perineal area, between the vaginal opening and the anus. During the procedure, the perineal skin, perineal muscles, and sometimes other soft tissues may be incised. These muscles may include the perineal muscles, puborectalis muscles, and deep pelvic muscles. This incision is made to facilitate the delivery of the baby or to prevent tissue tearing.