The process of childbirth cannot be fully planned. It is possible to predict the risks on the part of the mother and child, but it is impossible to fully know how the process itself will proceed, what complications will arise. Therefore, episiotomy remains a manipulation that is carried out unplanned, if indications arise during the course of childbirth.

Anatomical rationale

Episiotomy is a dissection of the tissues of the perineum in the second stage of labor. Anatomical structure perineum allows for a careful surgical incision to prevent tissue rupture and formation laceration. Healing during surgery is faster, with the formation of a neat, inconspicuous scar. With spontaneous rupture, the direction of the wound is unknown, it can lead to prolapse and prolapse of the pelvic organs, massive bleeding.

The structure of the perineum is such that the incision can be made in two directions, while the neurovascular bundles and large muscles are not damaged. If the incision is directed from the vagina to the anus, then this is a perineotomy, or median episiotomy. Another option is a mid-lateral episiotomy. A purely lateral incision is used very rarely, because. wounds after it heal worse, the risk of damage to the Bartholin gland is increased.

The difference between perineotomy and episiotomy is in the direction of the incision. In the latter case, it is performed along an imaginary line connecting the posterior commissure of the vagina with the right ischial tuberosity. This direction is preferable due to the location of the vessels and nerves of the perineum.

Indications for manipulation

Surgical intervention is not a whim of a doctor, but is carried out in case of a threat of perineal rupture. AT last years there is a decrease in the frequency of manipulation. This is associated with the rejection of elective episiotomy, as well as a trend towards a decrease in active aggressive labor management.

Episiotomy is also performed in the case when it is necessary to minimize attempts with increased blood pressure, high myopia, . The imposition of obstetric forceps or a vacuum extractor is not possible unless the opening to the vagina is widened. In some cases, after pain relief in childbirth, a woman loses the ability to push effectively. Then an episiotomy is needed to speed up delivery.

Indications may arise from the fetus. combined with high risk damage to the fetal head. In this case, a perineal incision is necessary to reduce pressure and speed up labor.

Other fetal indications include:

• when you need to expand the passage for the subsequent birth of a larger head;
• shoulder dystocia is observed when their size is larger than the head;
• large fruit;
• intrauterine, which is diagnosed during childbirth during CTG.

As an indication, a high rigid perineum stands out separately. It can be determined even before childbirth, the distance from the posterior commissure of the vagina to the anus will be more than 7 cm. With this type of perineum, perineotomy is permissible. Absolute contraindication for her there will be a low crotch - 2 cm or less.

Episiotomy technique

The incision is made only in the second stage of labor at the maximum of one of the attempts. The perineum is treated with an antiseptic. Local anesthesia is not always performed. With a threatening rupture of the perineum, the tissues are bloodless and stretched, so the incision does not cause acute pain. If anesthesia is necessary, it is performed in an infiltrative way with the help of Lidocaine solution.

The dissection of the perineum is performed with scissors. While the woman is resting from the push, one branch is carefully inserted between the presenting part of the fetus and the tissues of the perineum in the direction of the future incision. After the start of the next contraction, the woman in labor pushes, the tissues are stretched as much as possible. At this point, an incision is made.

Its length is determined intuitively, but it must be at least 3 cm. A “sparing” short incision will not give the necessary expansion of the exit from the vagina and may provoke further tissue rupture.

If an episiotomy was performed during childbirth, suturing (raffia) is performed after the birth of the placenta and examination of the cervix for ruptures. If anesthesia was not performed at the time of the incision, then infiltrative anesthesia is performed before suturing.

Are used various methods restoration of the integrity of the perineum:

1. Perineorrhaphy according to Shuta consists in the imposition of figure-of-eight sutures through all layers of tissues. Non-absorbable suture material is used. After the wound has healed, the threads are removed. The disadvantage of the method is frequent infection and inflammation of the sutures.
2. Layer-by-layer suturing of the perineum begins to be done from the mucous membrane rear wall vagina. Then, the cut muscles are connected with dip sutures. In this case, synthetic absorbable threads are used. Catgut is not recommended due to the large number allergic reactions. A continuous cosmetic suture is applied to the skin.

At the end of the manipulation, the sutured wound is treated with an antiseptic.

Seam care

The perineum area is very uncomfortable in terms of postoperative management wounds. From the genital tract suckers stand out, which serve as a breeding ground for microorganisms. It is impossible to fasten a sterile bandage to the seam or bandage it. There is always a risk of seam divergence if the woman in labor does not follow the doctor's recommendations.

How long can you not sit after an episiotomy?

Terms are determined depending on the size of the wound. In most cases, 2 weeks is sufficient. With deep incisions, the period is extended to 3-4 weeks. You can sit on your hip healthy side. Eating, feeding the child during this period will have to stand or lie down.

How long do stitches heal?

It depends on the correct processing. Under normal flow postoperative period, the absence of infection it lasts 5-7 days. At the end of this period, the doctor removes outer seam. In order for this process not to be delayed, it is important to follow certain rules:

• sanitary napkin change after 2 hours;
• after each visit to the toilet you need to wash yourself in a bidet warm water front to back and a solution of potassium permanganate to dry the skin;
• wipe the seam with blotting movements;
• after water procedures it is necessary to lie down without underwear to allow the perineum to dry completely;
• sutures in the maternity hospital are processed daily by a midwife, they are lubricated with a brilliant green solution, evaluated appearance and signs of inflammation.

When puffiness appears in the area of ​​​​the seams, physiotherapy is prescribed: ultrasound, laser therapy, tube-quartz. They improve microcirculation, accelerate healing postoperative suture. In the first few days, a heating pad with ice is applied through the linen to the wound area.

After being discharged home, the woman should ride in the back seat of the car in a reclining position. At home, you need to refrain from taking a bath for a month. Wash in the shower or bidet.

Nutrition should be balanced and not contain foods that have a fastening effect. Not recommended to eat bakery products. On the third day after childbirth, a laxative is given so that the woman defecates without straining. If stool problems occur at home, Microlax microenemas can be used to facilitate bowel movements.

Full recovery after episiotomy occurs no earlier than 1-1.5 months. Unpleasant sensations in the vagina can persist for up to six months. For better scar formation, it is recommended to apply Contractubex gel. It fights inflammation, stimulates cell regeneration without the formation of a keloid scar. But they begin to use it only after the wound has healed; it is forbidden to apply the drug to a fresh wound surface. The course of treatment is 4 weeks.

Possible complications and how to deal with them

As with any surgical manipulation, episiotomy can be accompanied by complications. During childbirth, it can aggravate obstetric trauma or continue with a grade III-IV rupture. it serious condition, which is accompanied by a rupture of the skin, muscles of the perineum, the external sphincter of the rectum and its wall. In severe cases, long-term effects may manifest as the formation of a vaginal-rectal fistula.

Seal in the suture after an episiotomy should alert. Also anxiety symptoms are:

• purulent discharge from the seam or genital tract;
• bad smell;
• a sharp increase in pain;
• asymmetry of the labia;
• long-lasting swelling or redness;
• fever, weakness and malaise;
• problems with urination.

If a woman does not follow the recommendations, she may experience symptoms that the seam has come apart. This results in bloody or sanious secretions from the wound. When such signs appear, the doctor removes the threads, and the wound heals on its own by secondary intention. Depending on the specific clinical situation, they may resort to re-suturing. A young mother may notice that the suture is bleeding after discharge from the hospital. Per medical care you need to contact your gynecologist.

Inflammation postoperative wound accompanied by swelling, severe pain. With suppuration, it is opened, washed with antiseptic solutions, drained. The woman in labor is prescribed antibiotics to suppress the infection.

How to treat stitches after an episiotomy at home?

It is enough to continue to use the same drugs that were prescribed in the hospital.

Asymmetry of the perineum, bulging in the suture area can be symptoms of a hematoma. Treatment depends on its size and rate of formation. Small hematomas are treated conservatively with antibiotics. If damaged large vessel, the hematoma rapidly increases in size, symptoms of anemia appear, it is necessary surgery. The wound is opened, the bleeding vessel is bandaged or stitched. The woman is also prescribed intramuscular antibiotics.

Long-term effects of episiotomy include dyspareunia - pain that occurs during intercourse. It is recommended to observe sexual rest up to 6 weeks after childbirth with a perineal incision. But discomfort can disturb a woman up to 3-6 months. To alleviate the condition, you need to choose poses in which the sensations are not so painful.

When can you play sports?

After 2 weeks, to improve overall well-being after childbirth, you can perform simple general strengthening exercises. After 2 months, with normal health, begin fitness or gymnastics in groups for beginners, gradually increasing the load.

Controversial issues and prevention

Scientists from North Carolina, USA conducted a number of studies in which the unjustified performance of an episiotomy was established. Complications and unpleasant consequences for a woman that affect general well-being and sexual life, force doctors to approach the manipulation more carefully. Gradually narrows the range of evidence. It is believed that with proper prenatal preparation, perineal tissues can be prepared, and adequate protection helps to avoid incision.

This leads to the avoidance of elective episiotomy, in many countries it is carried out according to indications that arose during childbirth. Execution serves as prevention and preparation. These are different muscle contractions. pelvic floor which are rhythmically repeated or performed in waves. Gymnastics can continue to be performed after childbirth starting from 3 days.

Reduces muscle stiffness intimate massage using any neutral oil. At the same time, the blood supply to this area improves, the tissues become softer and more elastic. To achieve the effect, 5 minutes a day is enough.

In childbirth, the prevention of rupture and a possible incision of the perineum will serve correct execution physician commands. Shouting during an attempt reduces its result and often leads to injury. Proper breathing, straining with due force and in right moment help give birth healthy child and minimal consequences for the mother.

During pregnancy, any woman feels fear of the upcoming birth. These fears are usually:

1. How will the birth go?

2. Does it hurt or not?

3. Will the baby be healthy?

And it is natural that all women are concerned about the question of whether they will need an episiotomy in childbirth. Many have heard that it hurts, and that the consequences after it are unforeseen, which is why they are afraid. Of course, this procedure, like any other manipulation, carries both pluses and minuses. Let's figure out what's what.

What is an episiotomy and what are its types?

Episiotomy - is a dissection of the skin and muscles of the perineum, which is performed according to indications, usually during the second period birth process. There are a few various types episiotomy:

• median episiotomy - a dissection is made in the middle of the genital organs, namely from the fold of the skin of the labia minora in the direction of the anus, leaving about 2 cm to it;
• lateral - the incision is made from the fold of the labia minora in the direction of the anus at a slight angle;
• unilateral - in a standard situation;
• bilateral - in difficult situations or when using tongs. The doctor makes a bilateral incision on both sides of the vagina before entering the rectum. Thus, the passage for the child expands, the use of instruments for obstetrics becomes possible.

Unfortunately, the number of episiotomies in Russia is still high. But gradually it began to decline. Previously, this procedure was performed for all women giving birth to a child for the first time, since there was an opinion among doctors that during the first birth, the skin and muscles of a woman are not very elastic, which is why the risk of birth trauma is higher than that of those who give birth for the second or third time. Now, episiotomy in Russia has been used as little as possible, and only according to indications.

How is an episiotomy performed?

The incision of the perineum is carried out in the second period of the birth process, in that period of time when the appeared head is no longer retracted without attempts. A sign that an episiotomy is necessary is considered a strong stretching of the vagina, causing the visible tissues to become whitish due to the outflow of blood.

Usually this intervention is performed without anesthesia, it is believed that at this moment the skin and muscles of the woman in labor are so thin that there is no pain. But, God, how wrong they are! Statistics show that there is pain, sharp, burning, but quickly passing. The dissection usually does not exceed 2-2.5 cm in length. The lateral episiotomy is mainly used, since the risk of rectal injury with it is minimal. With a median episiotomy, there is less blood and the sutures dissolve faster, but there is a risk of injury to the rectum, and infection occurs more often.

Indications for an episiotomy

Experts say that episiotomy incisions heal much faster than lacerations. In addition, the seams from such an intervention dissolve faster. This is directly related to the fact that smooth edges from an episiotomy are easier to sew up, and there are fewer stitches from it. But after breaks, especially of the 3rd and 4th degree, it is harder to sew up the perineum and more stitches are needed, because the edges of the gap are uneven.

Indications for episiotomy are:

• threatening rupture - the skin becomes thinner, turns pale and acquires a glossy sheen;
• large weight of the baby;
• rapid delivery - an episiotomy is done to avoid trauma to the baby;
• broad shoulders of the fetus or dystocia - in other words, “shoulders stuck”, although the head was born;
• applied before forceps or vacuum are applied - under certain conditions;
• too long second period of the birth process;
• at high pressure(hypertension) of the mother, an episiotomy is performed in order to shorten labor;
• lack of oxygen inside the womb;
• pelvic location of the fetus - the child comes out with the legs, not the head; usually with this position of the fetus, the vagina is stretched much more;
• poorly developed muscles of the perineum;
• weak generic activity when the strength of a woman is lost in attempts, and the child cannot get out quickly.

Stitches after episiotomy: stitching the incision after childbirth

Episiorrhaphy (suturing of vaginal incisions) is carried out after the birth of a child's place and subsequent thorough examination of the vagina with the help of mirrors. This manipulation is done under local anesthesia, usually using 0.25% novocaine or 2% lidocaine. To be honest, again according to statistics, these solutions are not able to anesthetize the surgical field. But in principle, the pain is tolerable, and you can endure for the sake of this. The incision is sutured in layers, in 2 rows. First, the deep muscles of the perineum are sutured, then the more superficial ones, after which the skin of the perineum itself is sutured. For sewing use Catgut. These threads dissolve on their own on the 10th day.

After an episiotomy: what to do?

The stitches heal within 2 weeks. During these 2 weeks, a woman cannot sit, and after their arrival, for some time she will have to sit on one healthy buttock, with her legs brought together. The baby has to be fed lying down. Well, actually, most of the mothers claim that it is more convenient to feed the baby in the lying position even after the postoperative period. In maternity hospitals, the seams are processed strong mortar potassium permanganate, it is only allowed to wash them laundry soap. Although it pinches more than usual, in the opinion of all the same mothers. Food is prescribed laxative, which does not cause the formation of solid stool to avoid splitting seams.

Once at home, you need to wash your genitals often, especially after going to the toilet, the pads are changed every 4 hours so that there is no infection. You can do "applications" with levomekol, so healing will happen faster.

2 months after giving birth, you can return to life sex. However, not all women are comfortable and easy at the first intercourse. The perineum is a highly sensitive area, and ruptures affect nerve endings, which may not always recover quickly.

Unfortunately, the doctor does not always sew up the incision after the episiotomy correctly, which is why a woman may feel sharp pain from stretching the seams and rubbing scars.

Our readers' stories: Natalia - could shrink the vagina after childbirth Natalia, 32 years old: After childbirth intimate life with her husband has ceased to bring former pleasure. Natural childbirth the vagina was greatly stretched, the husband did not feel anything, and neither did I. Kegel exercises and vaginal balls did not help - the last ones literally fell out of me. In addition, I suffered from pain and dryness in the vagina, because during childbirth I had an episiotomy. I was very afraid that my husband would get tired of it and he would "go to the left", my last hope became the Virgin Star cream, I learned about it at one of the large women's communities, where mothers like me shared their stories and miraculous recovery. This cream restored my vagina literally in a matter of days. Pain and dryness are gone, intimacy is even better than on our honeymoon! My husband does not get tired of making compliments, as far as I have "there" everything is narrow! I ordered this cream. on the official site .

At the first sexual intercourse, a man needs to be gentle. A woman may be disturbed by pain in the scar, pain during the introduction of the penis, dryness in the vagina, which often happens after childbirth. And this greatly increases the discomfort. Be sure to use lubricants, and also - try to make love more often so that your body gets used to it again.

Consequences and complications after episiotomy

Sometimes the following complications may occur:

• Swelling of the wound. Ice and painkillers will help to cope with it.
• The seams are coming apart. Re-sutures cannot be applied, so tissue regeneration must occur on its own, and this is a long time.
• Infection of the wound, drugs against infection, drainage, removal of sutures if necessary.
• Tumor wound. Removal of sutures, cleaning the cavity from the contents, the appointment of anti-inflammatory drugs.
• Pain during sex. May be felt for up to 1 year after birth period. After 12 months, the pain disappears. They are not that strong, but rather just unpleasant.

How to Prevent an Episiotomy

To prevent an episiotomy, it is advisable to prepare in advance for the upcoming birth, from as early as 32 weeks. Here it is recommended to perform the Kegel exercise. It is aimed at tension and relaxation of the muscles of the inguinal and, of course, the muscles of the pelvic floor. Training the muscles of the vagina makes the perineum elastic enough that you will be quite capable of avoiding tears and cuts.

It is also advisable to use after a shower. massage oil peach or wheat germ, to massage the perineum and vagina. Massage should be done for at least 20 minutes.

It turns out that crying during childbirth provokes tears, so avoid it. If possible, apply to the perineum in the first stage of labor warm compresses. In the second period, just listen to the doctor.

Well, now you know what the procedure is. And it turns out she's not that scary. Good luck.

Episiotomy - dissection of the perineum and posterior wall of the vagina 2-3 cm long during childbirth.

Reasons for an episiotomy

Episiotomy is carried out unplanned, depending on how the birth proceeds. This method is used to facilitate the birth process, when for some reason the tissues of the perineum do not stretch enough, and there is a threat to the health of the baby or mother:

• when severe ruptures of the perineum are possible;
• when there is a risk of injury to the baby's head;
• when there is swelling of the perineum;
• when a mother can be injured due to premature attempts;
• when general state mothers require acceleration of the birth process;
• when you need to use forceps or a vacuum extractor.

Seams after dissection

After the baby is born, stitches are applied to the incision site. Muscle tissues and mucous membranes are sutured with a special material, which is subsequently absorbed and does not require removal. The skin is sewn together mainly with a thread of medical silk. The procedure can take place under local anesthesia.

The sutures are removed 5-7 days after the operation.

Stitch care after an episiotomy

While you are in postpartum ward, every day you will be treated with seams (green paint, peroxide or a solution of potassium permanganate).

If in the first days after childbirth you experience strong pain painkillers may be prescribed. And with significant swelling, an ice pack can be applied.

Your actions after an episiotomy include bed rest, light diet to avoid constipation, washing after each trip to the toilet.
You will be prohibited from taking sitting position for 10-14 days, you will need to feed the baby first lying or standing. It is also forbidden to take baths in the next month (only shower and washing).

Seam healing period

Subject to all the rules of personal hygiene and the above-mentioned suture care, the sutures after an episiotomy heal in about a month and a half.

Complications

During suture healing, inflammatory processes due to hygiene violations. If you feel enough severe pain in a supine or standing position, pulsation in the area of ​​​​the seams, a feeling of fullness - be sure to consult a doctor.

In addition, the divergence of the seams is possible. It happens. If a woman began to take a sitting position before the permitted period or pushed excessively. If the sutures come apart before the wound heals, they are reapplied. If the edges of the wound have already healed and the divergence of the sutures is insignificant, the doctor may leave them in this position. If the sutures are completely separated, a second episiotomy is performed and the sutures are re-sutured.

Childbirth is a natural process for female body which cannot be planned. Many women take this issue seriously and try to find out all the details in order to be prepared for any surprises. A gynecologist can reveal risky situations for the mother and child, but he will not be able to name exactly what complications this woman in labor will have.

It is possible that it will be necessary An episiotomy is a minor operation during childbirth to help the baby come into the world. If you do not make a dissection, there will be a rupture of the perineum. A lacerated wound heals for a long time, with complications. The incision has smooth edges that are easier to fasten, which means that the rehabilitation process will go faster.

An episiotomy is a small obstetric operation, performed at a time when the child is already close to “exit”, but cannot exit for a number of reasons. The doctor prepares for the operation while the woman in labor is resting from contractions. One blade of scissors is gently inserted into the perineum at a 45 degree angle. It is necessary that it touches the skin, which is already stretched from attempts and resembles parchment paper.

As soon as the course of labor resumes, the doctor performs an incision. The woman in labor does not feel pain, her attention is focused on childbirth, therefore surgical intervention does without general anesthesia.

An injection of lidocaine or novocaine is given, but sometimes the situation becomes critical, and there is not enough time to give an injection. The cut is made instantly. After the baby is born, the perineum is sutured with surgical threads.

Types of episiotomy

Episiotomy is performed during childbirth so that spontaneous tissue rupture does not occur, because the direction of the laceration will be uncontrollable. There may be a prolapse of the pelvic organs, severe bleeding may open.

AT medical practice during childbirth, one of the two types of gynecological operations:

1. Standard type of dissection (anatomical) implies that the doctor mentally draws a line that starts from the buttock and ends at the back of the vagina, and makes an incision. Internal organs, nerve fibers, large muscles are not damaged. Bleeding may start, but it is easy to stop. This type of operation has one feature: if the incision is small, it can be extended.
2. The second type is perineotomy.- differs from the first in the direction of the incision - from the vagina to the anus. There are several types of perineotomy - median-lateral, purely lateral episiotomy. Indications for carrying out is a special anatomical constitution of a woman: high or, conversely, low perineum. The height of the perineum is determined even before childbirth. Pregnant women with such features should be prepared for a difficult course of childbirth. This type of surgery is risky because it can damage the Bartholin's gland.

Who is eligible for an episiotomy?

An episiotomy performed during childbirth is a forced measure carried out in the name of saving the baby or trouble for the woman in labor. Dissection manipulation is performed only if there is a threat to the life of the child or the woman in labor.

It is known from medical journals that 50 out of 100 women in labor undergo an episiotomy.

There is no predisposition to episiotomy, but the reasons for the operation may be the following:

Advantages and disadvantages of episiotomy

Nowadays, a small surgical operation to speed up the process of childbirth is often performed. It is better for a gynecologist to make an incision than to look for some new way help. The decision is made when the doctor sees that the child is in danger.

And only some time after the birth of the baby, the young mother can realize the fidelity of the manipulation performed:

• this operation did not affect the health of the child: he was born without injuries;
• childbirth passed - the pain was forgotten.

Gynecological manipulation has several disadvantages:

• there is a risk of injury to the rectum, a new operation will be required;
• may open bleeding;
• when suturing, the woman in labor experiences pain:
• for some time a woman who has given birth cannot sit;
• the healing process is long, it is necessary to comply with certain requirements;
• if the doctor's recommendations are violated, the seams may disperse;
• poor-quality wound treatment causes inflammation of injured tissues.

Is there an alternative?

Episiotomy during childbirth does not exclude Alternative option. What is it: the new kind surgical intervention or compliance with the advice of a gynecologist?

We are talking about the fact that a pregnant woman should consciously prepare for childbirth:

A woman should understand that it depends on her whether the child can be born healthy.

How is an episiotomy performed?

Episiotomy during childbirth: what is it, the incision technique is as follows:

The operation is performed in the second stage of labor, when skin and muscle tissue the perineum does not stretch and prevent the appearance of the baby's head.

How long do stitches take to heal?

The process and duration of healing depend on the application technique, the materials used for stitching and the condition of the woman in labor. Vicryl internal sutures dissolve on their own with catgut.

External staples, if there is no infection, the gynecologist removes after 5-7 days. In case of puffiness, physio-procedures (ultrasound, laser) are prescribed, which enhance microcirculation.

Complete healing occurs in a month, although the woman experiences discomfort for six months. To prevent scar formation, after the wound has healed, it is recommended to use Contractubex gel for a month, which causes cell regeneration. After about a year, the seams will be practically invisible.

Seam care: how and with what to process?

In the maternity hospital, a midwife, who evaluates the appearance of the wound, performs a simple procedure for treating sutures with brilliant green. Sanitary pads, which need to be changed very often, also save. Nor should one forget about women's rule": change the gaskets "front - back".

After a woman is discharged from the hospital, child care falls entirely on her, so she sometimes forgets about herself. And if you do not follow the recommendations of the doctor, the seams can become inflamed and disperse.

To do without unpleasant consequences, it is necessary to independently care for the seams:

The following are considered effective:

The treatment of seams with ointments should be done carefully. In the room where the woman is being treated, there must be sterile cleanliness, otherwise an infection may be introduced.

Intimate life after episiotomy

Episiotomy during childbirth was uneventful. What is this - a signal that you can have an intimate life or abstain for a long time?

Doctors advise not to resume sexual relations after 1.5 - 2 months. After this period, go to the reception women's consultation to make sure everything is ok. But, even if the seams were tightened without any complications, scars remained, touching which is painful.

In such cases, they massage the adhesions or lubricate the problem area with any ointment with an anesthetic effect. In addition, the uterus is still in an injured state.

It is possible that during sex she will be injured a second time. Difficulty intimate relationship due to vaginal dryness. This state possibly due to the low amount of estrogen in the blood. The problem is solved by using gels and lubricants for intimate hygiene.

You need to choose those that contain anti-inflammatory elements to eliminate the risk of infection in the genitals. A suitable ointment is Contractubex, which relieves inflammation and smoothes scars after surgery. The forces of the woman in labor are restored within 2 months.

The uterus returns to normal, microcracks on the mucous membrane of the genital organs heal, wounds heal. From that moment on, a full-fledged intimate life of the spouses returns to normal.

Does an episiotomy affect subsequent pregnancy and childbirth?

After an episiotomy, complications may occur:

• weakening of the immune system;
• tissues and sutures after the operation are not elastic;
• a new incision cannot be made in the same place.

However, in gynecology there are many examples when the second birth took place without surgery. Great importance also has a woman's mood, her preparation for childbirth. So a mother who wants to give birth to a second baby needs to discard all fears and prepare her body for a new test.

Possible consequences and complications

An episiotomy was performed during childbirth. What is it: the beginning of rehabilitation or a long process of treatment? The first days after the operation are the most important, because the wound is healing intensively. If this time has passed without complications, then the stitches are removed for the woman in labor.

However, there are several uncomfortable moments that an episiotomy brings:

1. The operation causes pain, which is not felt immediately, but after the birth is completed. Painful sensations pass quickly, but if the woman in labor has high sensitivity, then they can be stored for up to two months. In such cases, the doctor advises taking pills, such as paracetamol, ibuprofren, and putting anesthetic suppositories.
2. Scars can hurt, and upon examination, the gynecologist does not see any pathology. In such cases, physiotherapy helps to help, which can begin two weeks after childbirth.
3. Discomfort also increases the deterioration of bowel function. With a certain liquid diet, as well as the use of lactic acid products unpleasant moments pass.
4. Sometimes there is swelling, which will help to remove compresses or heating pads with ice.
5. Bleeding may occur, caused by microcracks or divergence of the edges of the stitched tissue. In this case, a new surgical intervention will be required. To speed up the healing process, the doctor prescribes a visit to physiotherapy, heating with a quartz or infrared lamp.

Within 2 weeks after the operation, the woman in labor should not sit to avoid pressure on the sutures. An orthopedic pillow helps out in such situations, round shape with a hole in the center.

Or you can use an ordinary inflatable ring. When the wounds stop hurting, you can begin to sit down. At first, you can sit down on one buttock, while the legs should be brought together. After a while, you can try to sit down in the usual way, but feeding the baby should be done lying down.

What to do if the seam festered?

Sometimes there is swelling of the perineum, which does not go away, then there is a seal, brown-green discharge with bad smell. The process began a long time ago, but many young mothers do not attach importance to this, in the hope that everything will pass.

When the temperature rises, weakness sets in, problems with urination begin, the woman understands that it is necessary to immediately contact a gynecologist. In the department, specialists open the wound and wash it. The woman in labor is prescribed pills and injections of antibiotics to suppress the infection.

The wound cavity can be disinfected with chlorhexidine or hydrogen peroxide. To speed up the healing process, the wound can be lubricated with Malavit gel, Levomekol, Solcoseryl ointments.

What to do if the seam has come apart?

It happens that after returning from the hospital, the seams begin to bleed. This is a sign that the seam is coming apart.

This can happen for several reasons:

• the woman in labor does not comply with the basic requirement: do not sit down for at least a week, because the skin is stretched and the wounds are exposed;
• the patient is taken hard work around the house;
• experiencing discomfort during defecation.

Secondary suturing is painful because the skin is inflamed and small sutures can lead to a rough scar that will be uncomfortable later on.

It's better if healing goes naturally. To speed up the process of wound healing and recovery skin must be stitched at night sterile bandage with ointment Chlorophilipt, Traumeel, which have a healing effect.

How to relieve pain and speed up healing?

Often, women in labor complain that the stitches hurt after surgery. It helps warming up with a red lamp, which can be done at home. Pain is relieved by ointments with an analgesic effect, such as Bepanten, Malavit.

For quick healing of sutures, you must follow the advice given by the attending physician:

A woman must follow all recommendations for daily care behind the seams, in them - hope for fast healing wounds. Those who have gone through such operations believe that nothing heals better than caring for a newborn. Doctors confirm that movement and active life will help you heal faster.

An episiotomy during childbirth is sometimes a necessity, and every expectant mother should know what this will bring.

• any pregnant woman needs to prepare her body for childbirth;
• on the Internet you can find a lot of literature to understand what the operation is;
• if you think that it will be easier for the child this way, then you can endure pain at the moment when the needle touches the skin; no pain is felt when the incision is made.

If you follow the seams, follow all the recommendations, then after a month there will be relief, and after 2 months - full recovery. Recovering in delivery room you need to believe that the birth will end safely, and that a beautiful baby will be born and the mother will be healthy.

Video: Episiotomy during childbirth

What is an episiotomy:

The girl will tell the story of her birth:

The birth of a child is a miracle. The expectant mother carefully prepares for the appearance of the baby. But during childbirth, an unforeseen situation may occur when an episiotomy may be needed. episiotomies are of particular concern in pregnant women. Let's talk about this in more detail.

What it is?

An episiotomy is a small incision in the perineum that is made to a woman in labor at the time of expulsion of the fetus. Usually before this expectant mother introduce local anesthesia, but sometimes there is no time for this, and they do without anesthesia.

This operation prevents spontaneous ruptures by helping the baby pass through the birth canal.

Who needs an episiotomy

Who is eligible for an episiotomy? Sutures after episiotomy heal for a long time. How justified is this procedure? The vaginal tissue is quite elastic. Nature herself ordered that a woman should give birth naturally without problems. But there are a number of special reasons for which an episiotomy is necessary:

• the child has a breech presentation, that is, he goes forward with his ass or legs;
• you need to speed up the birth, because the baby has hypoxia - a lack of oxygen;
• there is a risk of perineal rupture if the fabric is inelastic.

Unfortunately, in our time, this operation is put on stream, and it is done to almost every second woman in labor. It is easier for a doctor to make an incision than to come up with some other methods of delivery. If possible, it is better to find a trusted and experienced doctor in advance who will not allow surgical intervention. And of course, the mood for a successful outcome is important.

Pros and cons of an episiotomy

Usually, a woman giving birth already during childbirth is faced with the need for an incision, which is made using special surgical scissors. This, at first glance, terrible procedure has several advantages:

• the second phase of labor is accelerating;
• the child is born without injury, this procedure is safe for him;
• when trying, it takes much less strength from the expectant mother.

The disadvantages include the following:

• painful suturing;
• impossibility long time sit;
• can injure the rectum;
• long recovery after childbirth.

Despite such a huge number of disadvantages, one must still trust the doctors. And if the well-being, health or even the life of a child is at stake, then it is better to agree to a procedure such as an episiotomy. Stitches after an episiotomy may hurt for some time and cause discomfort. See below for how to care for them.

Can an episiotomy be avoided?

This surgery can be avoided. It has long been proven that premature birth usually end with multiple breaks. It would seem that this is a paradox, because the head of such a baby, of course, is smaller. But it turns out that a couple of weeks before giving birth, hormones are activated in the woman's body that increase the elasticity of the vagina. Therefore, you need to try to bring the baby to term.

In addition, you can independently prepare the perineum for childbirth. It's better to start early. Doctors advise to healthy lifestyle life throughout pregnancy, do not overeat and monitor weight. It is best to visit the pool or yoga for pregnant women, if the obstetrician-gynecologist does not mind and there are no contraindications in each case.

A month before the birth, you need to start doing an intimate massage with a special oil. If it was not possible to buy it, you can use sunflower, almond, olive or sea buckthorn. How such a massage is done is usually shown in courses for pregnant women, so they should not be neglected. This procedure must be done every day. Widely known will also help the perineum gain elasticity and return to normal condition after childbirth. In any case, if it so happened that the doctor had to make an incision, do not panic.

How long does it take for sutures to heal after an episiotomy?

If indications appear during childbirth, the doctor will carefully make an incision. Practice shows that he is usually with right side. Sutures are applied either with self-absorbable threads, or those that will need to be removed on the fifth day. Which threads to choose - the doctor decides.

In the first three weeks, you can not sit, otherwise there is a risk of divergence of the seams. There is also a ban on sexual life within 5-6 weeks. Usually during this period the sutures heal. Complete recovery of the vagina occurs within 6-9 months after childbirth, but only when taking into account proper care behind the crotch.

Perineal care after childbirth

What does a suture look like after an episiotomy? After childbirth, a woman can feel huge swollen scars. If you try to see yourself with the help of a mirror, then the spectacle will not be for the faint of heart. It's perfect normal phenomenon. If you follow the doctor's recommendations, then after 2 weeks the swelling will subside, and after another six months there will be no trace of it.

The most frustrating thing for many moms is the inability to sit. Feeding your baby standing or lying down is very inconvenient. But the health of the crumbs is more important, so you can endure a few weeks. If mistakes were made in the care of the perineum, then the risk of complications is likely.

Complications after episiotomy

Like any other surgical intervention, episiotomy can have complications. What to do, if the seam has come apart after an episiotomy, and what are the reasons for this? This can happen if a woman lifted weights, for example, carried a stroller with a child up the stairs, or sat down ahead of time. As soon as the first signs of a rupture appear, for example, the suture after an episiotomy hurts, you should immediately consult a doctor. You may need secondary suturing.

Sex after an episiotomy

In any case, after childbirth, it is necessary to refrain from sexual intercourse for 6 weeks. After this period, you need to visit a gynecologist. If everything is in order with the stitches and the doctor gives the go-ahead, then you can remember your

Most women who have had an episiotomy admit that they felt fear at first and that the discomfort will go away with time. For the first time, it is better to use a lubricant gel and spend more time. It is also worth experimenting with poses, choosing the right one. If the pain is unbearable, then you should stop and try in a couple of days. If the pain persists for several months and pulls the suture after the episiotomy, then you should consult a doctor for advice.

Can I still have a baby after an episiotomy?

Women who have undergone this surgical operation, usually worry about whether subsequent births are possible? Fortunately, there is no ban on this. It should be noted that an episiotomy may be needed a second time. Sutures after episiotomy are not elastic. Therefore, midwives, in order to avoid tearing the old seam, make a neat new incision.

In about half of the cases, the second and subsequent births pass without this intervention. It is necessary to tune in to a positive outcome of childbirth and carefully prepare for them. Having children is a must, despite the fear that episiotomy induces. Stitches after an episiotomy are such a small thing compared to the happiness that babies give!