When we women discover we are pregnant, inevitably one of the first thoughts is about the day of childbirth. What will it be like? Will I feel a lot of pain? Will everything go well? And unfortunately, this is a step that cannot be planned, because everything can change depending on the situation, even during an elective cesarean section. In the case of vaginal birth, one of the main concerns is about episiotomy.

What is Episiotomy

Episiotomy is a surgical procedure greatly feared by women and not mentioned in their prenatal appointments, where they often only become aware of it after experiencing it. It is a cut of about five to six centimeters made in the perineal region, between the vagina and the anus, which is made up entirely of muscles. The procedure is used to facilitate the passage of the baby during vaginal delivery, but is it always truly necessary?

When to Perform an Episiotomy

In the past, the procedure was performed in practically all vaginal births, with the aim of helping the woman during delivery and reducing risks to the baby, but more recent studies have shown that the method is more harmful than beneficial to women, and should only be used in specific and truly necessary cases.

However, many doctors still use the procedure, which generates an ongoing discussion about necessity vs. disrespect to women. Facts have already shown that even if a woman suffers a perineal tear during childbirth, healing is faster than with an episiotomy and the chances of needing stitches in the area are very small.

When is the Episiotomy Performed

Episiotomy is performed during delivery, when it is already possible to see the baby’s head, and after the birth, sutures are applied to close up the area. Healing can take up to 6 weeks, and the woman should avoid physical exertion and especially sexual activity. If it does not heal properly, the site can develop fibrosis, prolonged pain, and in more serious cases, loss of sensation in the area and looseness of the perineum, even leading to intestinal problems.

Indications for Episiotomy

Of course, every rule has its exception, and this is no different with episiotomy. There are situations that require medical intervention and help for the baby to be born more quickly, focusing on the health of mother and child. The most common indications are for women with high perineal rigidity, which makes it difficult for the baby to pass through, for breech births where the baby is not head down but sitting, and in cases of very large or overweight babies.

In very difficult deliveries where forceps or vacuum extraction are necessary, episiotomy is also indicated to avoid a more severe tear in the woman. That is why each case must be evaluated according to its circumstances and real needs to avoid even greater complications.

How to Avoid the Procedure

Some studies on the subject have pointed out a way to avoid episiotomy and allow vaginal delivery to take place as expected, without tears or stitches, which is perineal massage. Perineal massage aims to relax the muscles in the area, improving local elasticity and preventing the area from rupturing.

The procedure should begin from the 34th week of pregnancy and be performed once or twice a week. The massage aims not only to strengthen the perineal muscles but also to lessen the intense pain of natural childbirth.

The massage should be done inside the vagina and hands must be properly washed, clean, and nails trimmed. With the help of liquid or gel petroleum jelly or even pure vegetable oil, fingers should be used to lubricate the vaginal region. Both thumbs should be inserted about 3 cm facing downwards and pressed down and to the sides toward the anus until the area tingles; when it does, maintain the pressure for 2 minutes.

Talking to your obstetrician during prenatal visits to clear up all your doubts is also a way to understand all the procedures performed during childbirth. If you do not want an episiotomy, you can inform your doctor or even have it noted in your pregnancy card that will be given to the maternity when you arrive at the hospital.

See also: Natural Birth – Childbirth without Interventions

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