Episiotomy during childbirth - what is it, photos before and after the incision, how long does it take for the suture to heal, recovery, differences with perineotomy, cesarean. Episiotomy: consequences, photos of stitches before and after. Caring for the perineum after childbirth

Every woman remembers the birth of her baby as the most important and happiest event in her life. But no matter how strong the joy of meeting a baby, often physical state a woman in the postpartum period does not allow her to fully enjoy the first days of motherhood. Fatigue contributes to this hormonal changes, and physical pain, often associated with surgical interventions, and one of them is.

What is an episiotomy and why is it performed?

Episiotomy is a dissection of the perineum using surgical scissors, which is performed to prevent traumatic brain injury to the child and severe arbitrary rupture of the perineal tissue during childbirth.

Episiotomy is indicated for:

the threat of perineal ruptures during the birth of a large fetus
"high" crotch
improper entry of the fetal head into the pelvis
the need to shorten the second stage of labor due to gestosis, weakness labor activity, bleeding
fetal hypoxia
some diseases internal organs
premature birth
the need to apply forceps or a vacuum extractor

Incision of the perineum expands the vaginal outlet, reduces muscle pressure pelvic floor on the fetal head, speeds up labor and helps tissues recover faster ( lacerations heal much worse than cut ones).

How is an episiotomy performed?

The need for an episiotomy is determined by the doctor when observing the perineum during: the muscles tense to the limit and can no longer stretch, the tissues of the perineum turn white, their rupture becomes obvious, to avoid which an incision is made. To do this, the midwife inserts her fingers between the mother's perineum and the fetal head and, at the height of one of the attempts, cuts the perineum with blunt scissors. The length of the incision should not be less than 3 cm, otherwise it will turn into a laceration when the head comes out.

There is no need to be afraid of the incision: most women who were not given anesthesia did not feel pain. But anesthesia, on the contrary, reduces the plasticity of tissues, promoting their rupture.

There are 3 types of episiotomy:

perineotomy , or dissection of the perineum along midline from the vagina to the anus. This type is less painful, it causes less blood loss, and the suture heals fairly quickly. However, its complication may be a severe rupture of the perineum with damage to the rectum.
mid-lateral, or lateral dissection at an angle of 45°. This type is used most often.
lateral, or a lateral incision at an angle of 45°, but two cm above the mid-lateral incision. Such sutures do not heal well, so they are practically not used today.

In the postpartum period, the integrity of the perineum is restored by suturing through all layers of tissue (however, with this method, the sutures must be removed and they often become infected) or by layer-by-layer restoration with absorbable suture materials. In this case, the doctor must give local anesthesia so that you do not feel pain.

Consequences of episiotomy and recovery process

The recovery period after an episiotomy is usually painful and unpleasant.

The consequences of an episiotomy include:

discomfort and pain when walking and standing up
impossibility sitting after an episiotomy first weeks after birth
pain and burning when urinating
painful sensations during sexual intercourse

In the first days after birth, episiotomy may be further complicated by suture dehiscence and urinary incontinence. In the future, if the tissues do not heal properly, muscle failure and prolapse of the genital organs may occur. These complications occur infrequently, and with proper hygiene care the wound heals quite quickly. However, on full recovery It often takes several weeks or even months.

In the postpartum period, sutures are treated twice a day with sterile swabs with an antiseptic. When tissues swell, ice is applied to them or physical treatment is performed (ultrasound, laser). On the fifth day after birth stitches after episiotomy removed.

Compliance certain rules- the most important thing in the wound healing process, therefore:

After each visit to the toilet, it is recommended to wash the perineum with water
should be changed as often as possible sanitary napkin
Once or twice a day you need to give yourself air baths by removing your underwear, placing a towel and lying down for a while
you need to walk more to improve blood circulation and speed up wound healing after episiotomy
Constipation should not be allowed, and if you have problems with bowel movements, it is best to take a laxative.
at long-term pain and discomfort in the genital area, you should visit a doctor

There is no need to be afraid of episiotomy: today it is done only in cases where there are really indications for it. You can try to prevent ruptures with the help of prenatal preparation - special gymnastics for pregnant women and perineal massage. During childbirth, you may prefer not the usual lying position, but standing or sitting: in this case, incisions are required much less frequently.

Tune in for the best and listen to your doctor's advice during childbirth - this will help you avoid many problems. In any case, remember that the pains and difficulties associated with the birth of a child are temporary, and they tend to pass quickly and almost without a trace!

Despite the fact that the birth of a child is the happiest moment in the life of every family, it becomes a serious test for a woman. First of all, many mothers are scared upcoming birth. In this regard, they are interested in whether they will be successful, how easy it will be to endure, whether the child will have any deviations.

Pregnant women have great fear when they hear about episiotomy. During a conversation with friends who have already gone through pregnancy, they can learn about this very frightening procedure. Therefore, they have a strong desire to find an opportunity not to resort to this method. Of course, people perceive differently the need for a perineal incision. Therefore, episiotomy has both supporters and opponents.

What is episiotomy and its types

Women who are about to give birth for the first time probably do not have the slightest idea what an episiotomy is. In fact, this term refers to a perineal incision made surgically in the second stage of labor. In this case, the dissection can be performed in different directions, which allows you to highlight several types of episiotomy:

perineotomy or median episiotomy. With this type of surgical intervention, the dissection is performed towards the middle: the incision created goes from the frenulum of the labia minora towards the anus, not reaching 2 cm;
lateral or lateral episiotomy. This type of perineal incision is made from the frenulum of the labia minora in the direction from the anus at an angle.

A special group is formed by unilateral and bilateral episiotomy. However, it is the first method that has become most widespread. Bilateral dissection of the perineum is resorted to in cases where there is a need to apply obstetric forceps or other complications occurred during childbirth.

Alas, in our country there are quite a lot of cases of episiotomy, although in last years the percentage of use of this technique is decreasing. A couple of decades ago, doctors resorted to this method of surgical intervention during every birth, which was the first for the pregnant woman. However, in Lately the situation has changed, and today obstetricians try, if possible, to do without making such a perineal incision.

Usually the decision to carry out such a dissection is made in the second stage of labor, when fact of eruption of the head. In other words, at the moment when the head approaches the small pelvis and does not go back even in the absence of pushing. Most often, when carrying out such surgery they do not resort to painkillers, since the muscles and skin of the perineum are in a stretched state, which is why the pregnant woman does not feel any discomfort.

Typically, the perineal incision made is about 1-2 cm in length. In most cases, a lateral episiotomy is performed, which is more preferable because it minimizes the risk of damage to the rectal sphincter. Despite the fact that when performing a median episiotomy, there is less blood loss, and the healing process postoperative sutures takes less time, this option of dissection increases the likelihood of infection in the wound after childbirth.

It is believed that it is better to make an incision than to allow the perineum to rupture, since the former takes less time to heal and is better. The reason for this is that the incision made by the doctor available smooth edges , which are easier to fasten. In addition, the procedure for suturing second, third and fourth degree perineal tears is not only tedious, but also a lengthy process, not to mention the fact that wound healing takes longer. Although episiotomy provides a number of benefits, it can only be performed in certain situations:

Postoperative period

It usually takes time for the stitches to close after an episiotomy. takes about two weeks b. A pregnant woman should not sit down while recovering from an episiotomy. When the healing period comes to an end, she may be allowed to sit on only one buttock, but with the condition that she will be in contact with the surface with the healthy side of the perineum, while her legs should be brought together. Before feeding the baby, pregnant women need to take a lying position.

After completing the episiotomy, treat the sutures with a concentrated solution of potassium permanganate. Subsequently, the woman in labor must adhere to a laxative diet, which will facilitate easier passage of stool and help prevent the sutures from coming apart. When a pregnant woman is discharged, she needs to regularly wash the external genitalia using boiled water, after the next meeting of natural needs.

For an episiotomy, recovery involves regularly changing pads every four hours. For this purpose, napkins are used, which are previously apply levomekol ointment which helps speed up the healing process. Before it is possible to return to normal sexual activity, a woman will have to endure quite a long period of time. rehabilitation period during two months.

Consequences of episiotomy

Unfortunately, episiotomy does not always pass without leaving a trace for a pregnant woman. In some cases there may be certain complications and consequences:

Considering that many women in labor would like to do without this procedure, there are a number of recommendations that, even if they do not allow avoid unwanted cutting, then at least they will help reduce the risk of it being performed during childbirth.

Preparing for childbirth

If a woman has a good idea of how the birth will take place, then she is less overcome by fear, since she can soberly assess her condition and knows what needs to be done when the staff contacts her at a certain point in labor.

The experience gained during classes in a group of pregnant women or at home will provide good help. Then, during contractions and pushing, she will be able to take this position, change her breathing and relax to ensure best conditions for the fetus to come out.

Such actions on the part of the woman in labor will help bring the birth process closer to ideal and thereby reduce the likelihood of using an episiotomy.

If your birth will take place under a preliminary agreement or contract, then it will not hurt you to let your attending physician know in advance if you would like to give birth as naturally as possible.

Perineal massage

For this procedure to have the desired effect, massage must be performed regularly. at least 2-3 times a week. It can be done for the first time already at the 36th week of pregnancy.

During the massage, fingers are used, with which, after inserting into the vagina to a shallow depth, they begin to gently massage the perineum from the inside towards the anus. It is this area that stretches as much as possible during childbirth, thereby increasing the risk of damage. To achieve the effect, it is recommended to massage lasting about 3-5 minutes. If the woman does not feel awkward, then entrust this intimate procedure Possibly for a partner too.

Conclusion

Despite the fact that episiotomy is considered to be quite unpleasant surgical intervention, in some situations you cannot do without it. Therefore, in cases where it is simply necessary to make such a cut in order to so that the birth takes place without complications, a woman just needs to reconcile herself and cast aside all fears.

Although every pregnant woman has the opportunity to do without this unpleasant procedure, for which it is enough to prepare for future births. There are a number of activities that can improve the functions of the perineum, thereby creating favorable conditions for normal childbirth.

Episiotomy

As is known, labor pain It has wonderful property– she is quickly forgotten. Therefore, many women, remembering the birth of their child, only talk about how doctors “cut” them, as a result of which their life became more difficult in the first month after childbirth. As a rule, in this case we are talking about perineo- or episiotomy. We will tell you what these operations are, why they are needed and, most importantly, what a woman can do to avoid them or make these injuries less painful.

What is the perineum?

The pelvic floor, or perineum, is the internal support of our body, of all our internal organs. It consists of three layers of muscles. The muscles of the lower (outer) layer are arranged in the form of a figure eight, the rings of which encircle the vagina and anus. Middle layer represented by the triangular muscle. Finally, the upper (inner) layer forms the pelvic diaphragm. This is the paired and most powerful muscle of the pelvis, whose fibers create a real dome.

Such a complex structure and close connection crotch with genitourinary organs imply that this area is subject to heavy loads and plays an important role in the functioning of organs located in the pelvis.

Indeed, the pelvic floor is a support for the internal genital organs, bladder and rectum. Damage or weakness of this muscle leads to prolapse or even prolapse of organs and disruption of their functions.

In addition, along with the muscles abdominal wall and the diaphragm (the muscular septum separating the chest and abdominal cavity) the pelvic floor is involved in the regulation intra-abdominal pressure, which means it also affects organs located in the abdominal cavity.

During childbirth, these muscles stretch in a unique way, forming a wide tube through which the baby passes. After childbirth, they contract, returning to their previous position.

Causes of breakups

Unfortunately, no matter how ideally the perineal muscles are “designed,” there are many factors that reduce their elasticity and contribute to perineal rupture. Among them:

the woman’s age is more than 35 years, especially if this is her first birth;
high crotch (when the distance between anus and the entrance to the vagina is more than 7-8 cm);
developed muscles of the perineum (for example, in women who play sports professionally);
scars on the perineum after injuries received during a previous birth or as a result of plastic surgery;
swelling of the perineum (with weak labor, prolonged pushing);
fast and rapid childbirth;
insufficient protection of the perineum (reception provided by the midwife) when removing the baby’s head and shoulders;
inappropriate behavior of the woman in labor - during childbirth, especially during the second period, when the fetus is expelled, it is necessary to strictly follow the recommendations of the doctor and midwife who monitor the condition of the perineum.

Premature pushing, strong pushing at the moment when it is necessary to breathe through the contraction (at the moment of removal of the fetal head and shoulders), contribute to the appearance of ruptures.

Do not forget that the inflammatory process in the vagina (colpitis, vulvovaginitis) contributes to significantly greater trauma to the soft tissues of the birth canal. Therefore, all women are recommended to undergo smears for vaginal flora at 36 weeks of pregnancy and, if necessary, undergo appropriate treatment.

Tears can be internal (on the cervix and inside the vagina) and external (at the exit of the vagina). Cervical ruptures most often occur at the end of the first stage of labor, when the cervix has not yet fully opened, and the fetal head has already pressed against the entrance to the small pelvis, putting pressure on bladder and rectum; at the same time there is a desire to push and thereby get rid of the pain. However, this should not be done under any circumstances, since pressure on the cervix that has not yet opened leads to its rupture.

In turn, according to the principle “the force of action is equal to the force of reaction,” the cervix puts pressure on the fetal head and leads to additional injuries to the unborn child. The fetal head should descend slowly, gradually expanding the tissues of the vagina and perineum. Any forcing can lead to vaginal injuries - abrasions and ruptures.

To prevent this from happening, you need to listen to the recommendations of the doctor and midwife and not push before the head completely fills the entire vagina and reaches the exit from the pelvis. During the birth of the head and shoulders of the fetus, the mucous membrane of the labia may be injured. This occurs during rapid extension during her birth.

Degrees of perineal tear:

I degree: the posterior commissure is disrupted ( small area skin of the perineum between the entrance to the vagina and the rectum) and the vaginal wall. The perineal muscles remain unharmed.

II degree: the skin of the perineum, the walls of the vagina and the muscles up to the sphincter of the rectum are damaged.

III degree: The II degree rupture deepens, involving the sphincter of the rectum, and sometimes its wall.

When is a perineal incision necessary?

Exist the following readings to dissection of the perineum:

Threatening perineal rupture(occurs with a large fetus, high perineum, rigidity - poor extensibility of perineal tissue, etc.). Most often, the rupture begins at the posterior commissure and then moves to the perineum and vaginal walls. A break does not begin suddenly - it is preceded by changes appearance crotch.

Signs indicating an impending rupture include characteristic protrusion of the perineum, cyanosis, swelling, and then pallor of the skin. If obstetricians notice signs of a threatening rupture, they make an incision. This is done because the smooth edges of an incised wound heal better after suturing than the rough edges of a laceration.

Premature birth- to avoid pressure on the perineal tissues fragile bones skull of a premature baby.

The need to shorten the period of exile due to the condition of the woman in labor (increased arterial pressure, congenital and acquired heart defects, myopia, etc.).

Indications for episiotomy are the threat of rupture of the “low” perineum (when the distance between the rectum and the entrance to the vagina is small), acute subpubic angle (the angle at which the bones of the pubic symphysis meet), breech presentation of the fetus, scar changes perineum, obstetric operations (application of obstetric forceps, vacuum extractor).

Lateral episiotomy - an incision strictly to the side - is carried out only when pathological changes perineum that does not allow the use of another method of dissection (for example, for tumors) - such incisions heal less well.

Perineotomy and episiotomy are performed in the second stage of labor, when the presenting part of the fetus has sank to the pelvic floor and tension in the perineum appears, before its rupture occurs. The operation is performed by a doctor, in case of emergency in his absence - a midwife.

The perineotomy operation does not require pain relief, since ischemia (lack of blood supply) of the perineal tissue leads to loss pain sensitivity. Before dissection, the skin of the perineum is treated with tincture of iodine. The incision is usually made with scissors at the moment the fetal head erupts. Its length is on average 2-3 cm. Blood loss, as a rule, is small. Restoration of the cut perineum is carried out after the birth of the placenta.

Caring for seams

To identify injuries, after childbirth the doctor must examine soft fabrics birth canal. Regardless of whether it was a tear or a cut, the integrity of the tissue is necessarily restored. Whether pain relief will be used, and which one, depends on the degree of damage to the birth canal.

If a woman has only cervical ruptures, then anesthesia is not required, since there are no pain receptors in the cervix. Cervical tears are sutured with absorbable sutures (catgut or vicryl). There is no need to remove them.

If ruptures of the vagina and labia minora are detected, they are usually sutured under local anesthesia. As with cervical ruptures, as suture material absorbable sutures are used.

If the perineum has been damaged, depending on the depth of the wound, either local anesthesia, or intravenous anesthesia (in this case, the woman falls asleep for a short time). If epidural anesthesia was used during childbirth, then the woman is simply given an additional dose of anesthetic.

The integrity of the perineum is restored layer by layer. First, the muscles - deep and superficial - are carefully compared, then sutures are placed on the skin. If the sutures are applied with catgut, they do not need to be removed, but if with silk thread, the sutures are removed 5-7 days after birth.

IN postpartum period sutures on the perineum and labia are treated with hydrogen peroxide and a solution of potassium permanganate or brilliant green once a day. This is done by a midwife in the postpartum department. If the ruptures in the soft tissues of the birth canal were deep, then it is possible to prescribe antibacterial drugs– due to the proximity of the rectum and the possibility of infection.

For pain in the suture area, painkillers are prescribed in the first three days after birth; for swelling, the use of an ice pack is recommended.

How to behave?

If you have stitches in your perineum, follow a number of rules:

In the absence of contraindications, a woman is allowed to walk by the end of the first day after birth, and to sit 2-3 days after the stitches are removed (that is, on the 7-10th day after birth). In maternity hospitals where women eat not in the ward, but in the dining room, high tables (something resembling a bar counter) are provided for such postpartum women.
The baby will need to be fed while lying down.
When breaking III degree the first days you will need to adhere to special diet(broth, tea, fruit juices, kefir), so that there is no stool for 6-7 days. On the 7th day you will be given a laxative (you cannot push): it is advisable that the act of defecation should be as easy as possible.
Then you will be allowed to sit half-sided, on one of the buttocks - it is recommended to sit on the side where there is no incision (this can be done on the 5th day after birth), on a hard surface.
During your stay in the maternity hospital and during the week at home, after each trip to the toilet you need to treat the perineum (rinse it with running water, dry it well). It should be remembered that the washing movements should be made from front to back, from the pubis to the rectum, to reduce the likelihood of germs entering the wound. After this, it is advisable to lie down for a few minutes without underwear so that the skin dries on its own, and then you can get dressed, but do not forget to change the pads more often (every 2 hours), since the wound should be dry.

Possible complications

Pain, swelling, and wound infection, hematomas, abscesses. Whenever severe pain, feelings of pulsation and twitching, bursting in the area of the sutures, immediately complain to your doctor in order to exclude these dangerous complications.

If complications occur, the doctor will prescribe therapy, depending on the type of complication: frequent application of ice, treatment with ointments, or surgery. In the presence of cervical ruptures, especially deep ones, with accompanying inflammatory process may form in the vagina after suturing scar deformity– a state in which connective tissue scars deform the cervix.

In the future, this defect can be corrected using a laser, and in case of deeper damage, surgical correction– cervical plastic surgery.

Tears of the vagina and labia minora heal with virtually no consequences and without visible scars. However, with ruptures in the clitoral area, sensitivity in this area may be impaired, which is subsequently restored within several months.

Healing of the perineum can proceed without complications - only a skin scar will remain. In the presence of colpitis (inflammation of the vagina), sutures on the perineum may diverge. Formation of incompetence of the pelvic floor muscles with subsequent prolapse of the walls of the vagina and uterus.

In such a situation, a few months after birth you will need enough complex operation– vaginal plastic surgery.

Prevention

Is it possible to avoid tears and cuts? It is impossible to answer this question unequivocally. But, as already mentioned, a lot depends on the woman herself - on her calmness and willingness to follow all the doctor’s instructions.

What can you do on your end to try to avoid cutting?

Firstly, you should Be conscious about preparing for childbirth. You simply must be aware of the flow normal birth and ways of breathing and relaxing in them. This will allow you to get as close as possible to the physiological course of childbirth and avoid artificial interference in the natural process.

Let us also note that the likelihood of ruptures increases with rapid and stimulated labor, therefore, by skillfully and in time relaxing, moving correctly and, most importantly, without fear of the unknown, you will help both yourself and your baby.

Secondly, it will help you perineal massage, which should be done regularly. Starting from any period (optimally - from the middle of pregnancy, but if there are complications during pregnancy, in particular increased tone uterus, threat of miscarriage - then after 36 weeks of pregnancy) massage the perineum with vegetable oil every day or 2-3 times a week. It is best to perform a massage after a shower or bath in a state of relaxation and comfort.

Accept comfortable position– some like it lying down, others like it with one leg on a raised platform (for example, in a bathroom on the side). Pour 1 or 2 fingers with oil (it is better to pour it rather than dip it in oil - for hygiene reasons) and insert them into the vagina. Using pressing movements, massage it from the inside, especially towards the anus(this is where the maximum stretching will occur during childbirth).

You can try stretching the vagina to the sides. It is better to do this exercise not immediately, but when you get used to the massage: at first, stretching can be unpleasant due to inelastic tissues. The duration of the massage is at least 3 minutes.

At the same time, try to relax the vaginal muscles as much as possible - then discomfort will not be so strong (with a massage), and having learned such relaxation, you will be able to apply your skill at the moment the baby is born - then the risk of ruptures will further decrease, because there will be no “extra” tension in the perineum.

By the way, perineal massage will also help you if after childbirth the vagina becomes “too narrow” (this happens too!). To prepare a special oil for perineal massage, take a pack of St. John's wort and vegetable oil. Place the herb in a jar with a lid, pour oil on top and heat in a water bath for 15-20 minutes. Then put the jar in the cupboard for a week, after which it can be used.

If you haven't made a special massage oil, you can use any vegetable.

Third, systematically carry out special exercises aimed at gradually increasing the elasticity of the perineal tissues(consult your gynecologist about whether you can do such exercises and which exercises will be most effective for you).

In conclusion, I would like to say: tune in for the best, optimism and preparedness for childbirth will help you avoid surgery.

Kegel exercises

Slow compressions. Tighten your perineal muscles and slowly count to three. Relax. It will be a little more difficult if, holding the muscles, hold them in this state for 5-20 seconds, then gradually relax.

"Elevator". We begin a smooth ascent on the “elevator” - squeeze the muscles a little (1st floor), hold for 3-5 seconds, continue the ascent - squeeze a little harder (2nd floor), hold - etc. to its limit - 4-7 “floors”. We go down in the same stages, pausing for a couple of seconds on each floor.

Abbreviations. Tighten and relax your muscles as quickly as possible.

Pushing. Push down moderately, as if you are having a bowel movement. This exercise, in addition to the perineal muscles, also causes tension in some abdominal muscles. You will also feel the anus tightening and relaxing.

Start your workout with ten slow squeezes, ten contractions and ten pushes, five times a day. The exercises should be repeated at least 25 times during the day. You can do the exercises almost anywhere - while walking, watching TV, sitting at your desk, lying in bed.

When you first start exercising, you may find that your muscles don't want to remain tense during slow contractions. You may not be able to perform the contractions quickly or rhythmically enough. This is because the muscles are still weak - control improves with practice. If your muscles get tired mid-exercise, rest for a few seconds and continue.

Childbirth is not only an exciting, but also a rather unpredictable process, during which the child may encounter some difficulties while moving along the birth canal. For example, the baby will be too large for the mother and will not be able to be born without injuring the vaginal tract.

In such cases, the doctor performs the birth with an episiotomy. What is it and how to prevent it possible ruptures perineum at birth?

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Episiotomy – what is it?

Episiotomy during childbirth is a kind of preventative measure, which helps, through surgery (a small and precise incision in the soft tissue of the vagina), to prevent serious breaks crotch.

Such injuries to the entrance at the birth of a baby, directly at the moment of passage of the head, are, unfortunately, not uncommon.

Lacerations, unlike incisions, are more difficult to heal because they have torn edges. After suturing, a scar appears that is quite difficult for further resorption.

Sutures after an episiotomy are easier to treat and dissolve because the precisely cut tissues are placed on top of each other, and the healing process is faster.

Types of cuts

Cut the crotch to make it easier birth process mother and child, it can be done in different ways. How many types of such an operation are there?

There are 4 types of similar surgical procedures used in medicine, the first two of which are used quite often:

Mid-lateral - the incision is made in the middle between the opening of the anus and the ischial tuberosity. The obstetrician-gynecologist performs such an episiotomy diagonally to the right or left, depending on the situation.
Perineotomy - sometimes also called median. The difference between a perineotomy and a simple episiotomy is that the incision in in this case carried out exactly in the middle from the end of the vaginal opening to the opening of the anus.
Lateral - the incision is slightly angled and extends 1-2 cm from the end of the vagina. The lateral incision differs from the median one by a shorter distance and often occurs on the Bartholin gland, which is responsible for secreting lubricant in the vaginal passages. Due to the high risk of damage to this gland, this method is no longer used during childbirth.
“J” – episiotomy in the form of the same name English letter. The incision goes straight down the middle, as in a perineotomy, and then bends from the opening of the anus to the left or right by 1.5 cm. This method is also not very popular due to the risk of damaging the muscles leading to the anus.

Indications

In Europe, such surgical intervention began to be used less and less in order to protect the mother in labor as much as possible from postpartum scars. European doctors hold in high esteem a long period of pushing, during which there are practically no ruptures of the vaginal tract.

In Russia this operation used quite often to help women who have given birth avoid serious postpartum injuries and long recovery.

A Latin America generally introduced incisions such as perineotomy and episiotomy into the category of planned ones.

In addition, there are serious indications for:

risk of II or III degree perineal rupture;
the risk of stopping the supply of oxygen to the fetus, in this situation it is necessary to sharply tame the period of pushing;
the baby is too large for the mother;
rigidity (hardness) of the perineal muscles, in which they are so inflexible that they cannot allow the baby’s head to pass through;
There are prerequisites for instrumental birth, that is, you will have to help the baby be born using obstetric forceps. This is a rather controversial thing in gynecology, as they put pressure on the baby’s skull and lead to the appearance of various diseases subsequently, for example, paralysis. For a woman, the use of obstetric forceps also has its consequences: perineal ruptures and internal damage vagina. In this situation, making an incision will be a less traumatic option for both the mother and the newborn;
in the case of female circumcision - removal of parts of the perineum. Unfortunately, this practice still exists in a number of tribes and Islamic states. By and large, female circumcision is associated with the beliefs and religious prerequisites of a certain people, who decide in this way to cleanse a woman of “filth” and give her the opportunity to ascend after death to the divine kingdom. From a medical point of view, this is simply crippling. female body, making a woman sexually inferior and interfering with the birth process;
the fetus's heart rate slows down;
The baby's shoulders do not pass through the crotch.

Sutures after episiotomy

The suture heals after an episiotomy within one to two months: it all depends on individual characteristics body. The sutures are removed after the incision 3–4 days after birth. All this time the woman in labor is present pulling sensation, however, it goes away after the stitches are removed.

Attention! If self-absorbable sutures are used during surgery, the sutures do not need to be removed. They will disappear on their own within 2-3 weeks.

During healing, you need to keep the seam clean and constantly treat it with a solution of brilliant green. Afterwards (approximately 4–5 days after the baby is born), there is no need to process the seam.

It is enough to keep it clean, wipe it dry and wash it with soap without additives or dyes so as not to cause allergies.

You cannot sit after an episiotomy for about a month. Moreover, this applies mainly to full squats on the seam itself and on the soft surfaces of sofas, beds and chairs. In this case, ruptures may occur, especially if a perineotomy was performed, which takes longer to heal.

Is it really impossible to sit after an episiotomy? How to continue to lead normal image life? In this case, many learn to deftly bypass the unpleasant prohibition and either sit, but at the same time control the process of squatting: when sitting, choose hard chairs and transfer your body weight to the leg opposite the side of the cut.

In addition, you can sit on your lap and on a special inflatable ring - an analogue of children's swimming rings. The fact is that due to the hole, which is located in the middle, the load on the perineum becomes less, and therefore you can sit on such an inflatable ring, as well as on the rim of the toilet bowl, already in the first hours after the operation.

Second birth

Childbirth after an episiotomy may also occur naturally. If the situation with the fetus repeats and an incision is required again, it is usually carried out along the same scar to avoid new ones.

However, often the second birth differs significantly from the first, and the baby passes on its own, without incisions in the vaginal passages.

Why such an operation is performed is now clear. How to avoid episiotomy and subsequent stitches and scars?

In fact, this operation is necessary only in emergency cases, so it does not make sense for every woman in labor to do it, and often the woman herself can withstand a long period of pushing and wait until the perineal tissue stretches enough for the baby to come out.

In addition, you can prepare well for childbirth:

Best to learn proper breathing during childbirth: two short inhalations and a long exhalation, during which the muscles of the perineum relax.
Non-traditional methods have a good effect, such as preparing the vaginal passage for 9 months for the process of childbirth: rubbing special oils, such as almond oil, which helps increase tissue elasticity. One more unconventional method, helping to avoid ruptures is considered to be regular sex life during pregnancy (if there are no indications for sexual rest).
Keeping yourself in sports shape is considered a very good prevention, for example, exercise on a fitball, gymnastics for pregnant women, swimming and other light sports, such as jogging.

Important! Any sports exercises during pregnancy can only be performed after consulting a doctor.

Useful video

Thus, opinions on the topic of whether an episiotomy is necessary during childbirth, in modern medicine divided. Some obstetricians believe that this surgical incision prevents ruptures of the female genital organs and anus, while others speak out sharply negatively, believing that any interference in the process of childbirth will slow down the natural recovery of the female body.

However, the luminaries of medical science agree on one thing: this operation will help to avoid large blood loss during forced ruptures and will minimize future dysfunction of the genitourinary system.

Episiotomy is an incision in the perineum during childbirth, which is made while the baby is passing through birth canal. It was believed that such temporary artificial enlargement of a woman's genitals helps prevent spontaneous tissue rupture.

The number of incisions is decreasing every year, but experts believe that they are still made unreasonably often.

Who needs an episiotomy?

There are cases when dissection of the perineum is necessary:

to speed up the passage through the genital tract of a child who is experiencing;
to facilitate breech birth;
enlargement of the woman’s genital organs that are too dense and prevent ruptures towards their anterior part.

But these cases are quite rare. In other births, with proper control of pushing and local massage, this procedure can be avoided. It is known that vaginal tissue stretches quite well, but even if natural cracks occur, they are usually less extensive than the episiotomy seam.

What consequences?

It is already known throughout the world that the consequences of routine episiotomy are much more severe than all its benefits. Research shows that even if the baby is experiencing difficulties, the incision for the mother in labor will bring little benefit. more pain and suffering than benefit for the baby.

Possible problems that may arise:

tears in the anus or rectum, which may require surgery;
additional blood loss;
infections and swelling of the genital organs;
postpartum pain;
weakness of the pelvic floor muscles;
urinary or fecal incontinence.

How can you avoid an episiotomy?

First, discuss with the doctor who will deliver your child whether he/she performs this procedure to all women without exception. If yes, then it’s worth looking for another specialist who relies more on the experience of Western colleagues in his activities.

Kegel exercises.

These exercises tone the necessary muscles of a woman. They consist of contracting and relaxing the muscles of the genital organs, as if you are trying to hold back the urge to go to the toilet. Keep your muscles tense for about 10 seconds, then gradually relax. You need to repeat 10-20 exercises 2-3 times a day. It is advisable to start classes in the second trimester, but you can also do it at 37 weeks of pregnancy.

Prenatal perineal massage.

By using vegetable oil 6 weeks before the expected birth, you need to start massaging the perineum. You need to make U-shaped movements around the lower part, which is closer to the anus. About 5 minutes is enough to feel a slight burning sensation.

Attempt management.

Second and subsequent births

At repeated births women usually avoid cutting the perineum. My experience has been that if the vaginal area has been stretched once, the next time there will be very little or no tearing. Although scar tissue from an episiotomy during the first birth is not as elastic as normal tissue, anyway, this area stretches enough to let another child pass through it.

Tips for stitch care and recovery after an episiotomy

It should be said right away that if you have gone through this procedure, you will feel pain and swelling in this area for about 2 weeks. Wounds heal faster if:

keep them constantly clean;
wash yourself after each urination;
continue doing Kegel exercises;
drink more water so that the bladder is constantly working;
do not sit on flat surfaces at first;
if possible, allow the seam to “breathe” several times a day; to do this, you need to take off your underwear, cover yourself with a thin sheet and lie down with your legs bent for 10-15 minutes;
take care of the newborn (it is known that the suture heals faster with movement and active life women).