The concept of natural childbirth is gaining widespread recognition, as natural processes are considered the most beautiful and healthy. However, during natural delivery, to prevent perineal damage, a "perineal episiotomy" is often performed during delivery. This creates a neat incision in the perineum, facilitating suturing and healing, thereby minimizing the trauma inflicted on the mother during childbirth.
What is an episiotomy?
During labor, as the baby's head progresses through the birth canal toward the vaginal opening, it stretches and thins the perineum, making tears or even ruptures likely. Obstetrician-gynecologist Xiao Qixin explains that an episiotomy facilitates smoother delivery and creates a more manageable wound shape for suturing.
The perineal tissue is inherently thin and delicate. During delivery, the advancing fetal head exerts compressive forces that further compromise its integrity. As the head passes through the vaginal opening, varying degrees of tearing can occur due to the mother's pushing efforts.Dr. Hsiao further pointed out that in current obstetric practice, over 99% of primiparous women delivering vaginally undergo episiotomy to facilitate smoother labor progression.
Is episiotomy necessary for natural childbirth?
It's important to understand the three primary functions of the female vagina: First, it serves as the passage for menstruation, an inevitable monthly experience from puberty to menopause. Second, it functions as the channel for sexual intercourse, through which every mature woman experiences physical and emotional pleasure and fulfills the vital role of procreation. Finally, it acts as the birth canal for delivering the fetus. Consequently, the growth of the human female pelvis, though varying in its dimensions, is specifically adapted to allow the fetus to rotate and descend through it during delivery.
After conception, all bodily systems undergo changes to support fetal development and prepare for delivery. Particularly significant are hormonal shifts in estrogen and progesterone, which profoundly transform the reproductive system. These hormones act upon the uterus, cervix, pelvic ligaments, pelvic floor tissues, vagina, perineum, breasts, and more.By the final stages of pregnancy, these hormones soften the vulva, vagina, and pelvic ligaments, enhancing their elasticity to fully prepare for childbirth.
8 Key Points for Perineal Incision Post-Care
Recovery Time: Dr. Hsiao Chi-Hsin notes that perineal wounds heal similarly to skin tissue. Typically, mild discomfort occurs during the initial healing phase within the first two to three days. Pain usually subsides after about one week.
Finding Comfortable Positions: For the first two to three days after an episiotomy, new mothers may find sitting or standing painful. Sometimes leaning sideways causes more discomfort than sitting on a hard chair. If all positions hurt, try sitting on a rubber surface to reduce pressure on the perineum.
Since perineal wound pain can affect bowel movements, constipation is common. During the postpartum recovery period, it's especially important to consume adequate fiber to facilitate bowel movements. If necessary, consult your doctor about prescribing stool softeners to relieve constipation symptoms.
Apply ice packs within 24 hours post-surgery: Ice numbs pain and reduces swelling. Since discomfort is typically most pronounced during the first two days after surgery, ice packs can help minimize pain and swelling.
Warm baths after 24 hours: Dr. Hsiao Chi-hsin emphasizes that perineal wounds have good blood circulation and a low infection risk. After 24 hours of icing to reduce swelling, once home, take sitz baths twice daily (morning and evening) for 10-15 minutes each. Use lukewarm water (boiled and cooled) with iodine tincture.
Post-Bowel Movement Care: After each bowel movement or urination, thoroughly clean the perineal area to maintain hygiene. Add warm water to a perineal wash device and spray the area after using the toilet. Then, use a larger cotton swab or paper towel to wipe from front to back (from the urethral opening toward the anus). Discard the wipe after each use; avoid reusing it.
Change pads frequently: Lochia (postpartum discharge) typically lasts about a month. To prevent infection, do not skimp on pads—changing them regularly is essential.
Use antibiotics when needed: Persistent redness, swelling, or stinging at the wound site may indicate poor healing. Dr. Hsiao Chi-hsin advises new mothers to seek medical attention promptly if these symptoms arise. Clinically, antibiotics may be prescribed. Delaying treatment until infection develops can complicate the healing process.
Emergency follow-up: If redness, swelling, or stinging persists beyond one week, or if pus-like discharge or fever develops, return to the doctor immediately.