Those who aspire to become medical professionals need to have a thorough understanding of various medical procedures, including those commonly performed during childbirth. One such procedure is an episiotomy, which is required to ensure a safer and smoother birth under specific circumstances.  

As a NEET aspirant, it is essential to have comprehensive knowledge about episiotomies, including their uses, procedures, types, potential complications, and more.

What is an Episiotomy? 

An episiotomy is a medical procedure in which the obstetrician makes a small incision between the vaginal opening and the perineum during childbirth. This incision helps widen the vaginal opening, making it easier for the baby to pass through. In some cases, the perineum may tear naturally as the baby is born. This phenomenon is known as a perineal tear or laceration.

Generally, doctors discourage routine episiotomies and favour natural tearing. However, they may still perform the procedure in specific situations where it is deemed necessary.

What are the Types of Episiotomy Incisions? 

Episiotomy incisions generally fall into two main categories, each with its unique characteristics and risks. They are:

1. Median (Midline) Episiotomy

This involves a straight, vertical incision from the vaginal opening to the anus. Although it is easier to perform and repair, it carries a higher risk of extending into the rectum or anal sphincter.

2. Mediolateral Episiotomy

This type of episiotomy involves making a diagonal or angled incision starting from the vaginal opening at approximately a 45-degree angle. While it reduces the chance of the cut reaching the anal sphincter or rectum, it is generally more painful during recovery, causes greater blood loss, and is harder to stitch back together.

What are the Different Degrees of Episiotomy? 

Episiotomies, similar to perineal tears, are categorised based on the severity of the tear. Healthcare professionals typically classify them into 4 types of episiotomy based on degrees:

1. First-Degree Episiotomy

This involves a minor tear that affects only the vaginal lining, causing minimal damage.

2. Second-Degree Episiotomy

This tear extends beyond the vaginal lining and into the underlying vaginal tissues. It is the most common type of episiotomy.

3. Third-Degree Episiotomy

In this case, the tear goes deeper, affecting the vaginal lining, the vaginal tissues, and the anal sphincter.

4. Fourth-Degree Episiotomy

The most severe form, a fourth-degree episiotomy, impacts the vaginal lining, vaginal tissues, anal sphincter, and rectum. It carries the highest risk of complications.

What are the Benefits of Episiotomy?

The following are the benefits of episiotomy:

1. Controlled Incisions

Episiotomies enable healthcare providers to make precise and predictable cuts rather than dealing with spontaneous, potentially severe tears during childbirth.

2. Quicker Delivery

In some cases, performing an episiotomy can speed up the birth process, which may be crucial when a rapid delivery is needed to ensure the safety of the mother or baby.

3. Baby’s Safety

An episiotomy can reduce the risk of birth injuries, such as shoulder dystocia, where the baby’s head is delivered, but the shoulders get stuck, posing potential complications.

What is the Procedure for Performing an Episiotomy?

An episiotomy is typically performed during vaginal delivery, and the exact process may vary based on your obstetrician and medical condition. Here is an overview of the episiotomy procedure:

1. Administering Anaesthesia

To minimise pain, healthcare providers administer anaesthesia. If the patient has received an epidural, additional pain relief may not be required, as sensations from the waist down are already reduced. If not, a local anaesthetic is injected into the perineum.

2. Making the Incision

When the baby’s head crowns and exerts pressure on the perineum, the obstetrician uses episiotomy scissors to make a controlled incision.

3. Delivering the Baby and Placenta

Following the incision, the baby is delivered, and the placenta is expelled.

4. Repairing the Incision

The healthcare provider thoroughly examines the incision to assess the degree of the tear. Absorbable stitches are used to repair the muscles and tissues, ensuring proper healing and monitoring for any complications.

What are the Indications for Episiotomy?

Although episiotomies are now less common than they used to be, healthcare providers may still recommend them in certain situations. Typically, doctors allow natural tearing during childbirth, but there are specific scenarios where an episiotomy becomes necessary:

1. Fetal Distress

If the baby shows signs of distress and needs to be delivered quickly, an episiotomy can help speed up the process.

2. Prolonged Labour

When labour becomes extended, and the mother is exhausted or dehydrated, an episiotomy may assist in delivering the baby safely.

3. Assisted Delivery

Sometimes, doctors may need to use forceps or a vacuum to assist with delivery, and an episiotomy helps create more space to accommodate these instruments.

4. Breech Position or Shoulder Dystocia

If the baby is in a breech position (feet or buttocks first) or encounters shoulder dystocia (when the shoulders get stuck in the pelvis), an episiotomy may facilitate a safer delivery.

5. Large Baby Size

When the baby is larger than average, an episiotomy may help reduce the risk of severe tearing during birth.

6. Difficulty with Pushing

If the mother struggles to control pushing or has been pushing for an extended period without progress, an episiotomy can help expedite delivery.

What are the Complications of Episiotomy?

Episiotomies can lead to a range of complications, including:

• Excessive Bleeding

Increased blood loss during or after the procedure.

• Infection

The incision site may become infected, leading to discomfort and delayed healing.

• Painful Intercourse (Dyspareunia)

Scar tissue formation can cause pain during sexual activity.

• Rectal and Anal Sphincter Injuries

The tear may extend to the rectum, affecting the anal sphincter and causing functional issues.

• Scar Formation

Healing may result in noticeable scarring, causing long-term discomfort.

• Urinary Incontinence

Damage to muscles or nerves may lead to difficulties controlling urine.

• Extended Recovery Time

The healing process may take longer than expected, especially with severe tears.

It is essential to understand that natural tears may also cause some of these complications, emphasising the importance of personalised care during childbirth.

How to Recover After an Episiotomy?

Experiencing soreness in the perineal area after an episiotomy is normal and may last for a few weeks. To manage discomfort and support healing, consider the following tips:

1. Pain Relief Medications

Over-the-counter (OTC) pain relievers like acetaminophen or ibuprofen can help manage discomfort, but always follow your healthcare provider’s advice.

2. Cold Compress

Use a perineal cold pack or ice pack to help reduce swelling and soothe the area.

3. Warm Sitz Baths

Taking warm sitz baths can aid in healing and offer temporary relief from pain.

4. Peri Bottle for Hygiene

Rinse the area with warm water using a peri bottle during bathroom use to maintain cleanliness and comfort.

5. Numbing Sprays 

Applying numbing sprays can help reduce pain and itching around the incision site.

6. Doughnut Pillow for Sitting

Sitting on a doughnut-shaped cushion helps minimise pressure on the perineal area.

7. Witch Hazel Pads

Placing witch hazel pads on the area can help soothe irritation and promote comfort.

One must always consult their healthcare provider before resuming activities like having sex, using tampons, or inserting anything vaginally. Follow the doctor’s guidance to ensure a smooth and safe recovery.

FAQs About Episiotomy 

1. What are the common complications of episiotomy?

Possible complications include excessive bleeding, infection, painful intercourse, anal sphincter injuries, scar formation, urinary incontinence, and prolonged recovery.

2. What are the benefits of undergoing an episiotomy?

An episiotomy can be beneficial in specific circumstances as it helps lower the risk of severe natural tears. Healthcare providers perform this procedure when it is deemed the safest option for either the mother or the baby.

3. How much time does it take to recover from an episiotomy?

Healing from an episiotomy usually takes about a month, although the duration may vary depending on the type and severity of the incision. Natural tears also tend to heal within a similar timeframe.

4. How can one manage pain after an episiotomy?

Pain relief methods include using cold compresses, numbing sprays, pain relievers, warm sitz baths, and sitting on a doughnut pillow. Always follow healthcare provider recommendations for the best results.

5. Can I resume normal activities after an episiotomy?

It is advisable to avoid strenuous activities, heavy lifting, or sexual intercourse until the area has fully healed. Your healthcare provider will give specific recommendations based on your recovery progress.

Conclusion

Episiotomy is a medical procedure that can aid in safer and quicker deliveries when necessary. Understanding its uses, types, methods, and potential complications is crucial for NEET aspirants preparing for medical entrance exams. By gaining insights into episiotomy, you develop a well-rounded understanding of obstetric care, which can prove valuable in your medical journey.

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