Some mothers experience uterine prolapse due to severe damage to the vagina and perineum, or even tears to the anal sphincter and rectum, leading to painful fecal incontinence. If an episiotomy is performed promptly, these complications can be avoided, benefiting both mother and baby. Therefore, an episiotomy should only be used as a last resort.
Under what circumstances is an episiotomy permissible during vaginal delivery?
Episiotomy should only be performed as a last resort
During natural childbirth, the perineum may present five possible conditions: intact perineum or first- to fourth-degree tears.Grade 1 or 2 tears are relatively minor lacerations that do not affect postpartum recovery and heal quickly: Grade 1 tears, if not bleeding, often require no stitches and heal spontaneously—similar to a minor crack in the mucous membrane at the corner of the lips in winter. Grade 2 tears involve the subcutaneous tissue and only require a few internal stitches with absorbable sutures, which do not need removal.
What must be avoided are third-degree or higher tears. These severe lacerations compromise anal tissues, muscles, or even the rectum, making episiotomy a crucial preventive measure. A doctor or midwife uses scissors or a scalpel to make an incision in the perineum, widening the vaginal opening to facilitate delivery. Two primary techniques exist: a vertical incision along the vaginal plane (perineal midline incision) or an oblique incision at approximately a 40-degree angle to the vaginal opening (perineal lateral incision).After the incision, sutures are applied: 4-5 stitches on the surface skin and several dozen stitches internally.
In fact, episiotomy is by no means a routine procedure and should only be performed when absolutely necessary.
Premature High-Heel Use Contributes to High Episiotomy Rates
Experts indicate that changes in modern lifestyles are one reason behind China's high episiotomy rates.Many women now begin wearing high heels shortly after adolescence, unaware that this practice affects overall pelvic development. High heels increase the angle of the pelvic inlet, making it difficult for the fetal head to descend during delivery. Additionally, episiotomy rates in Western developed countries like the UK and US are only around 30–40%. The relatively high rate in China is partly fueled by tense doctor-patient relationships.In the UK, while episiotomy rates are low, perineal tears during childbirth are high. However, women who experience perineal tears rarely pursue legal action against doctors.Episiotomy can also permanently damage the vaginal mucosa and submucosal layer, injure perineal skin, subcutaneous tissue, and even perianal muscle structures, reducing the resilience of pelvic floor muscles. Many expectant mothers, influenced by posts about episiotomy, develop fears about vaginal delivery, with some even backing out and opting for cesarean sections.Expectant mothers primarily worry about two aspects of episiotomy: pain and its impact on sexual intimacy. First, doctors typically administer anesthesia before performing an episiotomy. Second, the vaginal area is not highly sensitive to pain, and the pressure from the baby's head during delivery can numb the nerves in the vagina. Therefore, expectant mothers need not be overly concerned about pain.
As for the impact on sexual intimacy, the reality is far less severe than imagined. Whether or not an episiotomy is performed, vaginal delivery naturally causes some relaxation of the vaginal walls. However, due to the presence of vaginal muscles and folds, recovery typically occurs within an acceptable range.
Conversely, opting for a cesarean section solely to avoid an episiotomy is unwise. Cesarean delivery carries over ten potential complications for both mother and baby—for instance, children born via cesarean have a higher risk of pneumonia than those delivered vaginally.
Weight Management Prevents Episiotomy
Pregnant women opting for vaginal delivery who wish to avoid episiotomy should follow their doctor's guidance on mental health, nutrition, and exercise from the start of pregnancy. Achieving balanced nutrition, engaging in appropriate exercise, and controlling both maternal and fetal weight are prerequisites for reducing the episiotomy rate during vaginal delivery.
How to care for an episiotomy wound?
1. Keep the wound clean and dry
After discharge, women who underwent an episiotomy should clean the perineal area daily with plain water or a cleansing solution. If possible, clean twice daily. Use safe sanitary products and change them promptly to maintain dryness and cleanliness.If swelling or pain occurs around the incision site, use a 0.02% potassium permanganate solution (adjust concentration until water turns pink) for sitz baths. Alternatively, apply a heating lamp to the incision to accelerate healing.
2. Avoid straining during bowel movements
After urination or defecation, rinse the perineum with water using a forward-to-back motion, similar to wiping with toilet paper, to prevent bacterial infection.
3. Avoid lifting heavy objects
Women who underwent episiotomy should refrain from lifting heavy objects or engaging in strenuous physical activities for one month postpartum.For these mothers, any premature or strenuous physical activity may damage pelvic floor tissues or even lead to uterine prolapse. 4. Avoid sexual intercourse during recovery Women who underwent an episiotomy should abstain from sexual intercourse for 6 weeks postpartum. After 6 weeks, sexual activity may resume only if the doctor confirms the uterus and birth canal have healed adequately.
5. Dietary Guidelines
Increase intake of high-fiber foods to prevent constipation. Stay well-hydrated by drinking at least 2000 milliliters of water daily.
6. Promptly Inform Your Doctor if Wound Exhibits Any of the Following Conditions:
Wound Hematoma: Severe pain at the incision site within 1–2 hours after suturing, progressively worsening and potentially accompanied by anal heaviness.
Wound infection: Within 2–3 days postpartum, the wound shows redness, swelling, heat, or pain, sometimes with hard lumps and pus-like discharge when pressed.
Wound dehiscence after suture removal: In rare cases, the wound may split open after sutures are removed. If already discharged, seek immediate medical attention.