An epi what?!? An episiotomy...

During childbirth, your body is put to the test in many ways. One of the most common procedures during a vaginal birth is an episiotomy. But what exactly is an episiotomy? And how does it differ from a tear or abrasions? What can you do to prepare your perineum for childbirth, and what is the best way to care for a tear, cut, or small wound? In this article, gynecologist Elisabeth Smet tells you everything you need to know.

The difference between an episiotomy, a tear, and an abrasion

Stretching of the perineum (the skin between the vagina and the anus) during vaginal childbirth can lead to injury. This can result from abrasions or a tear, but also from an incision made during delivery. The latter is the infamous episiotomy.

During an episiotomy, the midwife enlarges the opening for the baby by making a small incision in the perineum. An episiotomy can make the recovery process more difficult, but it is recommended in some cases.

Examples include assisted deliveries (such as vacuum extraction, or less commonly, forceps), cases where difficulties arise during the delivery of the shoulder (shoulder dystocia), situations where there is concern that a natural tear could compromise the integrity of the anal sphincter, etc.

According to the report on perinatal health in Flanders, nearly 35% of women who gave birth vaginally in 2021 underwent an episiotomy, and there was a noticeable downward trend, with the rate dropping to 32.8% between 2012 and 2021. Read below to learn how to best care for your perineum after an episiotomy.

A tear is caused spontaneously by the baby passing through the birth canal. A tear is classified by grade (from 1 to 4) depending on which tissues are involved in the injury (skin, muscle, anal sphincter).

A tear can occur in the vulva, perineum, vagina, or, rarely, the cervix. A large proportion of women who give birth vaginally (85%) experience a tear, the vast majority of which are first- or second-degree tears. In 0.6% to 11% of deliveries, the tear is more severe. Depending on the degree of the tear, it may or may not require suturing.

An abrasion can be described as a superficial wound on the vulva. In many cases, the abraded perineal tissue does not require stitches.

How do you treat a cut, tear, or scrape?

The best way to care for your perineum after giving birth is to rinse it with clean water after each trip to the bathroom. Use a perineal wash bottle, such as our flush bottle, for easy and painless rinsing. The targeted and gentle stream makes cleaning the perineum easier.

You may want to use a softening agent such as the intimate solution. This natural formula has a nourishing, soothing, and antiseptic effect.

How do you use it? Intimate Solution 10 ml Intimate Solution in 300 ml of lukewarm water and rinse your intimate area. Always dry your intimate skin thoroughly after rinsing to promote the fastest possible recovery.

You can also relieve the pain by applying heat and/or cold (alternating between the two) (for example, using anice pack). Never apply a heat or cold source directly to your skin; always use a barrier, such as a thin towel, to protect your intimate skin.

Finally, you can also take a sitz bath several times a day filled with 15 cm of lukewarm water.

What are the possible consequences of a cut, a tear, or an abrasion?

It usually takes up to 6 weeks for a cut, tear, or scrape to heal completely. Until then—and sometimes even afterward—you may experience pain in your genital area or a burning sensation when you urinate.

It is important to manage this pain to prevent urinary retention. Lukewarm water (from a shower or perineal bottle) during urination can often help relieve the pain.

In some cases, inflammation may develop. Symptoms of inflammation include persistent pain, redness, swelling, discoloration, and, rarely, a fever. If you have any concerns, always consult your doctor or healthcare provider.

Can you avoid a cut, tear, or scrape?

Studies show that prenatal perineal massage during the final weeks (starting at 35 weeks) of pregnancy can help prevent trauma (i.e., an episiotomy or tear) during childbirth (a 9% reduction for first-time mothers) and reduce postpartum discomfort.

Prenatal perineal massage is a stretching technique that optimally prepares the perineum and the final part of the birth canal for the baby’s passage. This also helps you understand what it feels like to experience tension in your perineum, so you’re already mentally prepared for vaginal childbirth.

Starting in week 35, you can stretch the vaginal opening and the perineum weekly, or even daily. For this, it’s best to use an oil that is safe for the microflora and promotes tissue elasticity, such as peri oil spray.

Conclusion

Most women experience a tear or abrasion during vaginal childbirth. So you’re definitely not alone! Take good care of your perineum before and after giving birth to avoid any discomfort later on.

Do you have any questions? Please contact us at shinncare. We’ll do our best to help you.