The Kindest Cut
Often, just before delivery, an episiotomy is performed. This procedure involves an incision in the perineum, which is located between the vagina and the anus. The cut enlarges the opening of the vagina to help ease the exit of the baby's head from the vaginal canal.
Medical opinion long held to the idea that an incision was better for the mother than running the risk of an unpredictable vaginal tear. Doctors believed incisions healed better and more quickly than tears. But new research shows that this was an erroneous way of thinking and that in fact, tears heal better and faster than cuts. For this reason, the episiotomy is no longer a routine procedure during birth.
The episiotomy is still performed in these circumstances:
*The baby needs an urgent, immediate delivery
*The baby is in an awkward position
*The head of the baby is larger than the vaginal opening
*There is evidence of fetal distress
*A vacuum or forceps delivery is necessary
*The mother is exhausted and unable to exert control over her pushing
Some midwives believe that an episiotomy can be avoided by softening the tissues in this area prior to the birth. If you want to try this, begin massaging your perineal tissue with olive oil or vaginal lubricant at around 6 weeks before your delivery date. The massage is done by placing your two thumbs at the opening of the vagina and pressing down toward the rectum. Hold for 2 minutes. Then massage the lower portion of your vagina in slow circles for ten minutes. Repeat these steps twice a day. Some women find their pregnant bellies get in the way. In this case, ask your partner to do the massages.
By doing regular Kegel exercises, you also help prevent the need for an episiotomy. You can also try applying warm wet compresses during your labor. It may also be helpful to stand or sit on a stool or birthing chair during your delivery to let gravity do its thing, rather than to lie prone on a table at this time.
If you prefer to avoid an episiotomy, write this out in your birth plan. Your doctor may need to do this procedure anyway, but if he's not absolutely convinced an episiotomy is necessary and you've specified you'd prefer not to have one, he should be able to honor your wishes.
The episiotomy takes 6 weeks to heal. The stitches used are dissolvable. Wash the area down with warm water each time you urinate and pat dry.