Episiotomy.

What is an episiotomy?
An episiotomy is a surgical incision in the area behind the vagina, above the rectum; it is made during delivery to avoid tearing the vaginal opening or rectum.

Will I have to have an episiotomy?
This is something you need to discuss at your prenatal visits. Most women having their first or second baby will have an episiotomy. The more children a woman has had, the less likely she will need an episiotomy. It depends on the size of the baby. There are some situations that do not require an episiotomy, such as a small baby or a premature baby. Often the decision cannot be made until the time of delivery.

Why does a woman have an episiotomy?
An episiotomy is done to allow room for the baby to fit through the birth canal and to avoid tearing into other organs in the mother. If a woman has had a few pregnancies and deliveries, she may not need an episiotomy with her later children.

What factors determine whether I have to have one?
Some factors to consider include the following:
•   the size of the mother's vaginal opening
•   the size of the baby's head and shoulders
•   the number of babies previously delivered
•   whether it will be a forceps or vacuum delivery

I've heard some episiotomies are bigger than others. What does this mean?
Description of an episiotomy includes a description of the depth of the incision. There are 4 degrees that describe incision depth:
•   1 st degree—cuts only the skin
•   2nd degree—cuts the skin and underlying tissue, called fascia
•   3rd degree—cuts the skin, underlying tissue and rectal sphincter, which is the muscle that goes around the anus
•   4th degree—goes through the three layers described above and the rectal mucosa, which is the lining of the rectum

How painful is an episiotomy?
After delivery of your baby, the most painful part of the birth process might be your episiotomy. Don't be afraid to ask for help with this pain. Many options are available for pain relief, including pain medication, ice, sitz baths and laxatives.