PERINEAL TEAR

During vaginal delivery, some women may sustain some injuries as the baby passes through the vagina that may require some stitches while for some, a cut might be given by the midwife or obstetrician that is taking the delivery. The cut given by the midwife or obstetrician during delivery is called an episiotomy. An episiotomy is an incision made on the posterior vagina mucosa and perineal skin to widen the vagina for easy passage of the baby. The Perineum is the region in between the thighs involving the vagina excluding the anus. Episiotomy used to be routinely given in the past but it is no longer recommended for routine use during delivery. The reasons for its routine use in the past was that, it is a well-controlled cut that is easy to repair than a spontaneous tear that is more likely to be ragged and extensive. The world health organization in 1996 discouraged the routine use of episiotomy and recommended a decrease in the rate to about 10%. This has been achieved by some Western countries but in Africa the rate still remains high.

WHEN IS EPISIOTOMY GIVEN

It is given in the second stage of labour when the cervix is fully dilated and the baby’s head has crowned that is, the baby’s head is in close contact with the vagina opening and the vagina opening forms a rim around the baby’s head. At this time, the baby’s head does not recede when the uterine contraction (labour pains) wanes. The cut is then given at the height of the uterine contraction that is, when the contraction is strongest, this is done at this time because the head of the baby will press against the cut and reduce bleeding.

HOW IS EPISIOTOMY GIVEN

When the time comes for it to be given, the site chosen for it is injected with lidocaine a medication meant to numb the area and prevent pain. However, when a woman is on epidural analgesia, there may not be a need for the injection. The midwife or obstetrician will place the fingers of the other hand between the baby’s head and the vagina to prevent injury to the baby. A scissor is then introduced between the fingers and the vagina. At the height of the uterine contraction the cut is given.

WHO GETS AN EPISIOTOMY

Your healthcare provider cannot tell with certainty if you will be given an episiotomy or not unless your history during the booking clinic is indicative for an episiotomy. That’s why your healthcare provider might likely talk to you about it during your antenatal care to get your consent because there may be no time to get an informed consent when an episiotomy is needed. As earlier mentioned it is not routinely given, episiotomy use is individualized, unlike in the past when almost every woman having a baby for the first time or one who has had an episiotomy in the past is given. There are indications to be met before an episiotomy is given and they include;

• A very tight perineum, scars from previous tear or female circumcision threatening to tear.
• When the baby is big
• Delivery of a preterm baby to prevent trauma to the baby’s head
• When the second stage of labour is prolonged due to resistance from the perineum
• When the baby is coming with the buttocks
• When instruments are to be used for delivery like forceps or vacuum.

COMPLICATION OF EPISIOTOMY

The complication could be to the mother or baby, immediate or late. The immediate complication could be;

• Bleeding
• Pain
• Perineal swelling
• Injury to the baby

The late complications could be Infection of the wound, breakdown of the repair or painful sex.

HOW TO CARE FOR AN EPISIOTOMY WOUND

It is very important to take care of the wound as some of the complications are due to infection from poor wound care. Your healthcare provider is most likely to place you on antibiotics to prevent infection and pain medication to make you comfortable. Perineal care using a warm Sitz bath also help. Read here to know how to make and have a Sitz bath. Wash with water after urinating or defecating and do not use a single pad all day. Ensure proper hand hygiene while handling your pad.

WHEN CAN SEXUAL ACTIVITY RESUME?

After an episiotomy, the woman could feel soreness or discomfort while walking or sitting, sexual intercourse is a no go. However, sexual intercourse can resume whenever the woman feels comfortable. An uncomplicated episiotomy wound should heal between 4 to 6 weeks.

WHEN SHOULD YOU BE WORRIED

Seek health care when the site of episiotomy opens up, when the wound starts discharging fluid or pus, when the pain becomes severe or when a painful mass forms around the area.

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