Episiotomies and Perineal Tears
An episiotomy is a cut made between your vagina and anus to aid the delivery. Around 30 years ago, episiotomies were routine since it was assumed that a cut prevented worse tears. This has been shown since not to be the case, and today, an episiotomy is only done by a doctor to aid a forceps delivery or in an emergency, for example if the baby is in distress; if the baby is large; or if the perineum is tight. Before doing the procedure, the doctor should explain why they think it is necessary and should obtain your verbal consent.
Before you're cut, you'll have a local anesthetic to numb the area. The cut is usually done at an angle between the vagina and the rectum and will be stitched after the birth. The doctor will insert a long absorbable stitch in the posterior wall of the vagina, in your perineal muscle layer, and under the skin layer. If you feel discomfort, the stitches can be snipped or taken out.
You may be given oral analgesics for pain relief after you've been stitched, and anti-inflammatory medication may be recommended. Ice packs or a maternity cooling gel pad can ease pain and swelling, and bathing can be soothing.
Some women tear naturally during the delivery of their baby and this tends to be more common in a first labor. Spontaneous tears are classified by their severity and the tissue layers involved. A first degree tear involves the skin layer only; a second degree tear involves the skin and muscle-tissue layers; a third degree tear involves skin, muscle, and the anal sphincter. Fourth degree tears are uncommon and involve a tear through to the rectum. A first degree tear usually doesn't need stitches, but second, third, and fourth degree tears do. Second degree tears are the most common. Only, a small number of women sustain third or fourth degree tears, which are usually associated with assisted deliveries.