Episiotomies....What you need to know

Episiotomies….Who Does That Anymore?!?!?

Say What

So…..I recently walked into a labor room and one of the first things out of the expectant mother’s mouth was, “I don’t want an episiotomy”!

I quickly replied, “either do I”! I mean, who does, right?

Pregnancy is one of “those times” where you get A LOT of unsolicited information. I mean, folks somehow just feel obligated to share their own pregnancy stories AND their thoughts relating to YOUR current pregnancy….everything from how horrible their labor and delivery experience was, to how they had an episiotomy cut from end to end, to how it looks like YOU are 36 weeks as opposed to 24 weeks….I mean,  I could go on, and on, and on.

Though it is occasionally good to draw on the knowledge/experience of family/friends who have had their own pregnancy adventures, I oft times find that such stories, while at times helpful, more often than not serve to add to the angst already experienced by the expectant mother.

Episiotomies are one such topic! Of late, I’ve found that a lot of what women think/know about episiotomies in general is soooooo dated!

In a nutshell, Here’s what I think you need to know:

What is it?!?!? An episiotomy is an incision made in the perineum, which is the skin between the vaginal opening and the anus. This is typically done with scissors.

ROUTINELY cutting Episiotomies is sooooo old school! Once upon a time the thought was that routinely cutting episiotomies would help prevent more extensive vaginal/perineal tearing, and help preserve the pelvic floor/musculature. The current literature does not support this school of thought.

While not routinely done, there are INDICATIONS when episiotomies are necessary. For example, needing to expeditiously deliver the baby for either maternal or fetal indications, needing more room to safely deliver baby(big baby), vaginal tearing seems inevitable(some prefer a “clean” tear), etc.

LABOR DOWN!!!! Let the baby help YOU! Laboring down, or allowing baby to descend into the pelvis and pushing, NOT when you are complete, but when YOU feel the urge to push, allows baby to help stretch the perineum. This, and occasionally my midwife friends resort to massaging the perineum, or applying warm compresses to help soften, loosen up the tissue.

There are two types of episiotomies... Midline, and Mediolateral. Midline episiotomies are cut straight up and down(between the vaginal opening and the anus). These are easiest to repair though have an increased risk of extending into the anus. Mediolateral episiotomies are cut at an angle. They are more “painful” with regards to healing, a bit more challenging to repair, but serve to lessen the risks of extension into the anus.

Last but not least, WE HEAR YOU! Always make sure that you express any concerns that you may have regarding your pregnancy and upcoming delivery. WHAT YOU THINK MATTERS! Labor is at best UNPREDICTABLE. Make sure your provider is keeping you in the loop.

You don’t want an episiotomy. We don’t want to have to cut an episiotomy. Remember, you and baby’s safety is ALWAYS first, and if such is needed, so be it!

Hope this blog post adds value to your day!

Until next time,

Look Better. Feel Better. Be Better.

Dr. Angela

 

 

About Dr. Angela

Wife, mother, Midwesterner, and award-winning OB/GYN, Dr. Angela is equal parts best girlfriend and bold professional, supporting women’s health with innovative approaches to care and heavy doses of humor. Dr. Angela has done more than launch a successful practice, she has defined herself as a voice for a new generation of womanhood, established her ASK DR. ANGELA brand committed to authenticity, and built a community rooted in trust, candor, and compassion.

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