It speeds up the birth and facilitates the expulsive phase in cases of operative births: theepisiotomy it is widely performed and it is the prerogative of the physician to determine if it is necessary to proceed with that small surgical enlargement of the posterior portion of the vagina that is obtained by an incision at the level of the perineum during the last part of the expulsive period of labor. It is a small cut, a few centimeters at the most, but which can cause a lot of discomfort for women period after parturition. Is it possible to take measures to avoid the need for an episiotomy during childbirth? Answers Federica Pasi, gynecologist at the IRCCS San Raffaele Hospital in our city
- When performing an episiotomy
- Episiotomy and perineal massage
- How to avoid episiotomy during childbirth
- Episiotomy pain: how long does it last?
- Treat an episiotomy after returning home
"The use of routine episiotomy is not recommended and the decision whether or not to carry out the episiotomy, therefore, must be evaluated case by case - the specialist says -. There are no absolute indications to perform the episiotomy, but there are cases in which the same may be advisable.These situations include:
The necessity of deliver the baby quickly, for example in cases where the cardiotocographic trace is no longer reassuring and suggests the need to carry out the birth quickly.
Operative vaginal delivery: If it is necessary to apply an obstetric suction cup, increasing the space at the level of the vagina and perineum can facilitate the application of the suction cup.
Shoulder dystocia: in some cases to allow obstetric maneuvers that serve to disengage the shoulders and to increase the space at the level of the vagina and perineum ".
"I perineal massages, carried out both during pregnancy and during the second stage of labor, reduce muscle resistance and, consequently, the possibility of perineal lacerations - clarifies the gynecologist -. Massages, even during childbirth, make the tissues more elastic and the risk of having to resort to an episiotomy is also reduced ".
Read also: Skin-to-skin contact with the newborn: the benefits of the "skin to skin" practice
How to avoid episiotomy during childbirth
I perineal massagesprecisely, in the prenatal period they can improve tissue elasticity and therefore prevent episiotomy - specifies the gynecologist -. Also some locations can prevent the use of episiotomy during labor. Specifically, it would be better to favor lateral positions, on all fours, semi-extended. In any case, inviting the woman to move during labor and to assume free positions improves the "perineal" outcome.
"Pain following the episiotomy can have variable duration. Generally it reduces a lot within the first week after giving birth - adds Pasi -. There are patients, however, in whom the pain can persist for a long time or even become a chronic pain. This can depend on the intrinsic characteristics of the patient (each heals in a different way, there are patients who have a tendency to heal poorly and form keloids), from an incorrect suture technique, from complications that may arise (infection of the surgical wound or formation of perineal hematoma) and it is therefore possible to feel the pain of the episiotomy scar after years ".Read also: How to Dress the Episiotomy Wound
"It is very important to take care of personal hygiene - concludes the gynecologist of the IRCCS San Raffaele in our city -, in fact the area of the perineum is subjected to continuous stimuli and muscular and infectious. The area should always be kept clean and dry. There are also several products to be applied on the surgical wound which can facilitate healing and prevent infections. These products favor the natural re-epithelialization process of even deep skin lesions and, if applied regularly, allow good local healing and avoid abnormal formation of fibrous tissue which are those that could then cause pain in the long term ".
Federica Pasi, gynecologist of the IRCCS San Raffaele Hospital in our city.
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