Episiotomy: The untold truth

Episiotomy is one of the interventions that might occur during vaginal delivery. Is this incision necessary all the time? Can it be avoided? Read on to learn the answers.

dr karen.webp
Karine Chahda
Published on:Jul 31st 2022 |Updated on:May 10th 2024
شق العجان

What is Episiotomy?

It is an incision done to the area between the vagina and the rectum. Sometimes this area tears up during vaginal delivery, when the head comes out fast, or because the perineal tissue is not flexible enough. The surgical incision is made by the doctor or midwife, based on their medical assessment of each case. During episiotomy, patients are under the effect of epidural or local anesthesia. 

Are episiotomies necessary?

Episiotomies are not necessary for all vaginal deliveries, and they can be avoided by following these steps:

- Doing Kegel exercises during pregnancy to strengthen the pelvic floor.

- Massaging the perineal tissues that consist of mucus, muscle, and skin, to help stretch them.

Perineal massage during pregnancy

It is recommended to massage the perineum to make the tissues more flexible. I advise pregnant ladies to do this massage after the shower by placing two thumbs inside the vagina and the rest of the fingers around the perineum. Another massage method is by placing the index and the middle finger inside the vagina and stretching it downwards.  This massage can be done using safe-to-use oils or lubricants for a few minutes each time. The husband can do this massage, especially during the last few weeks of pregnancy. It is noteworthy that this message is to be avoided in case of any vaginal infections or bleeding.

- Yoga poses help to strengthen the pelvic floor and avoid an episiotomy.

- Hot packs placed on the perineum during labor help stretch the area.

- Perineal massage during the pushing stage.

- Delivery position, when the mother is on all fours, is best to decrease pressure on the perineum and avoid any tears.

- Slow, guided, and gradual pushing during labor in addition to using lubricants.

It is noteworthy that despite all these precautions tears can still happen, and an incision might be needed, for many reasons such as:

- The need to extract the baby using forceps or vacuum, then a proper medical incision is needed to avoid a tear that can reach the rectum.

- A big baby head.

- Previous episiotomy.

- Not being sexually active, as intercourse increases the perineum’s flexibility.

I recommend that expecting mothers talk to their doctor before delivery and agree on not having an episiotomy unless it is medically necessary.

Episiotomy care

- Use anti-inflammatory ointments that can also heal the wound.

- Sitz baths (after the doctor’s approval).

- Hygiene of the area.

- Pain killers.

- Avoiding intercourse for six weeks.

- Avoid constipation, by staying hydrated and consuming high-fiber foods.

- There is no need to see the doctor remove the stitches, they come out on their own.


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dr karen.webp
Karine ChahdaMidwife Nurse

A new mom and Licenced Midwife, she holds a degree from the Lebanese University. Karine worked in the NICU unit at St. George University Hospital in Beirut. Then, she worked as a Midwife in the same hospital for five years. She joined the maternity ward at Danat Al Emarat Hospital in Abu Dhabi in 2021. Karine has a great passion for her role as a Midwife; she believes it is a blessing from God to witness the miracle of life born from another life. She thinks nothing is more beautiful than witnessing this miracle daily through her work. Karine believes that each of us has a specific role in life. She sees her role not as a job but as a vocation where she can assist others, and she is grateful for this blessing.

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