Womb to Bloom - Maternity & Beyond

The first of my four babies weighed 10 pounds, 4 ounces. Yikes. Despite my hopes to the contrary, he was born with the assistance of a last-minute episiotomy. Yikes again. I hadn’t really thought much or read much about episiotomies before I delivered my son – so I just went along with whatever the doctor said. Looking back, I think that she ultimately did the right things for me and for my baby but I wish that I had been a little more informed at the time.

An episiotomy is a surgical cut of your perineum (the muscular area between your vaginal opening and your anus) made just before delivery. It is done to enlarge your vaginal opening to assist in the birth of your baby. One of the common reasons for an episiotomy is a big baby, like mine. Other reasons include a baby in distress that needs to be delivered quickly and the possibility of multiple perineal tears. (I had a second episiotomy because the stitches I received after the first one did not heal well at all – so my OB re-cut me in order to do fix the effects of the first one. It was a very painful recovery but I healed so much better the second time. Unfortunately, it is not terribly uncommon for women to have imperfect healing after an episiotomy.)

Obviously, it’s best if you can avoid an episiotomy altogether. Talk to your obstetrician about his or her thoughts on episiotomies (they are still fairly common but are generally not standard procedure anymore). Some doctors think that episiotomies heal easier and better than tears – but many believe that there is no perceivable difference. The best way to avoid tears and episiotomies both is to do perineal massage for a few weeks before your due date and to ask your labor nurse, midwife or obstetrician to continue perineal massage during your labor. This will hopefully thin and relax your perineal muscles enough to allow the baby to be born without tearing or cutting.

If an episiotomy cannot be avoided, it will be done by the obstetrician with a pair of surgical scissors. Yes, scissors. My husband, who watched all four of my children being born including the entire c-section of my last two, admits that seeing the episiotomy done with scissors was the one thing that got to him. Made his knees a little weak. I didn’t feel a thing, thanks to my epidural and my wonderful and lovely anesthesiologist. If you are delivering without a pain block, the doctor can give you a shot of local anesthetic before making the cut.

Anyway, so the obstetrician makes the cut and the baby is born. Then the OB has to sew up the cut. There are several layers of stitches because it is skin and muscle that were cut. The stitches eventually dissolve, so thankfully they don’t have to be removed. Recovery from an episiotomy is honestly pretty uncomfortable though. 

A nurse will immediately give you some ice packs to keep your perineal area fairly numb and to reduce swelling. You did just birth a relatively large baby from there after all! Anti-inflammatories and pain meds will help with the recovery pain. As you might imagine, though, two rather necessary activities will continue to cause some discomfort for a few weeks while your stitches heal and your swelling subsides: sitting and using the bathroom.

For at least the first week after having my first two kids, I carried a Boppy nursing pillow around the house with me. I couldn’t sit on any surface without it – think of it as an industrial-sized donut pillow. It allowed me to sit without any direct pressure on my stitches.

With regard to the bathroom issue, listen to the advice of your nurses. The hospital nurses are your friends. My nurses recommended four important things: witch hazel wipes (usually marketed for hemorrhoids), a squirt bottle (they will likely give you one of these in the hospital), Dermaplast pain relieving spray and stool softeners.

The hemorrhoid wipes or pads are used after you use the bathroom, to help ease any swelling “down there.” The squirt bottle is, believe me, going to feel much better than toilet paper to keep your stitches clean (remember, you’re going to have quite a bit of bleeding and discharge for a while after the baby is born). I never thought I’d fear a square of toilet paper so much… The Dermaplast spray is possibly the best medical invention ever. Okay, so that’s a bit of an exaggeration but it numbs you right up. And that’s a good thing. Mark my words, you’ll end up buying more after you get home.

As weird as it might be talk about, stool softeners are a really necessary part of this post-partum recovery equation. Think about where that episiotomy cut occurred. Think about the fact that the only thing holding together that tissue is a few stitches. And then think about the mechanics of having a bowel movement. Can you see where this is going? It’s going to take a few days for you to regain any sort of regularity in this department and before it happens, you’re going to fear it happening. I don’t want to scare you but I don’t want to soft-pedal it either. The pressure can be pretty painful. And only more so if you don’t regularly take your stool softeners. Send your partner to buy them, it’ll be good for him. Heh.

I think that the average recovery time for episiotomy stitches is four to six weeks. The worst of the pain generally subsides after a week or two. You will usually get the go-ahead to resume sex with your partner, assuming that your perineum has completely healed, at your six week check-up with the obstetrician. I definitely recommend that you drop by the drugstore for some condoms and some lubricant whenever you choose to start having sex again. Even if you’re breastfeeding, you really can still get pregnant unless you are using some form of birth control. Ask me how I know and I’ll tell you about the time I found out I was pregnant again when my first child was five months old…

So, good luck on avoiding an episiotomy! But if you do end up having one, now you hopefully know what to expect and what to put on your drugstore shopping list to help your recovery.