An episiotomy is a surgical incision through the perineum, which is the area between the vagina and anus. An episiotomy enlarges the vagina during childbirth. Previously, this incision was a routine procedure in childbirth. However, current research indicates that most episiotomies are not necessary and may lead to more complications than they are intended to prevent. For example, episiotomies can lead to weakened pelvic floor muscles and anal incontinence. Despite current research, episiotomies are still one of the most common medical procedures performed on women. 

So, what can you do to avoid an episiotomy? Ask your caregiver if they routinely use episiotomies and let them know your preference. Studies have shown that controlled delivery of the head can help the perineum stretch and reduce both tears and the need for episiotomies. Some healthcare professionals recommend perineal massage beginning at around 34 weeks gestation.  Strengthen your pelvic floor muscles by doing Kegel exercises.

In some situations, episiotomies are recommended – for example, if the baby’s heart rate drops in the last stages of labour and the baby needs to be delivered quickly or if severe tearing looks likely. If you have an episiotomy or tear during delivery, the wound may hurt for some time, especially when you walk or sit. However, you can take steps to help heal the incision.


Giving Perineal Massage

Perineal massage helps stretch the skin much in the same way that the baby's head stretches it during birth. Massage your perineum once or twice a day, starting around the 34th week of pregnancy. After about a week, you should notice an increase in flexibility and stretchiness.

To massage the perineum, perform the following steps:

Wash your hands.

Find a private place and sit or lean back in a comfortable position.

Put an unscented lubricant, such as olive oil, coconut oil or pure vegetable oil, on your thumbs and around the perineum.

Place one or two thumbs about three to four centimetres inside your vagina. Press downward and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling or stinging sensation.

With your thumbs, hold the pressure steady for about two minutes or until the area becomes a little numb and you don't feel the tingling as much.

As you keep pressing with your thumbs, slowly and gently massage back and forth over the lower half of your vagina, working the lubricant into the tissues. Continue this for three to four minutes.

As you massage, hook your thumbs on the lower part of the vagina and pull gently outward and forward.                        

If you and your partner are comfortable, you can also ask your partner to help you with this massage.

If you find the perineal massage painful or uncomfortable do not continue it. Even without doing this you can very well have a normal delivery. 


Doing Kegel exercises

Find your pubococcygeus (PC) muscle.  The easiest way to find your PC muscle is to stop the flow of urine while you are urinating. Do this several times until you can clearly feel the muscle you are using to stop the flow. This muscle is your PC muscle. 

Contract this muscle as hard as you can and hold it for three to five seconds then relax for five seconds.

Repeat as many times as you can. 10 times is recommended and the exercises may be repeated up to 4 or 5 times a day or as many times as you wish.

To coordinate your breathing with the kegel exercise, begin to contract the PC muscle on the exhalation and slowly release the muscle on the inhalation. It an help to practice a visualization exercise as you do this. As you exhale imagine that an elevator is going up one floor, two floors all the way up to five floors. Begin with the muscles around your vagina and with each floor contract your muscles higher and higher in the pelvic region. Briefly hold the contraction at the fifth floor. As you inhale, slowly start to release the contraction, moving from the fifth floor down to the first.

Healing after an episiotomy:

Keep the area cool for the first 24 hours postpartum by using an icepack.

Switch to heat after 24 hours to increase blood flow to the area and help in healing.

Keep the wound clean.  Fill a squirt bottle with warm water and a disinfectant such as betadine and gently rinse the  from vagina to anus after using the toilet.

Pat the incision with gauze soaked in witch hazel or use haemorrhoid pads to reduce swelling.  In Bangalore, witch hazel can be found at shops that sell aromatic oils (try Fancy Shoppes or even a store like Spencer’s).

Sit is a shallow 'sitz bath' with warm water and betadine twice a day for 10-15 minutes.

Expose the perineum to air for 10-20 minutes at least once a day and especially after washing or sitz bath.  A fan can be used to dry the area.

Ask your healthcare provider to prescribe an anti-inflammatory.

Drink plenty of fluids to avoid dehydration, which can make bowel movements difficult.

Be aware of signs of infection, such as swelling, fever, increased pain or discharge, and notify your healthcare provider if you develop any of these.   

Do Kegel exercises to speed recovery.