Your Pregnancy After 35 : Labor and Delivery (part 4) - Will I Need an Episiotomy?

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Intravenous Drip (I.V.)

Some women are concerned about having an intravenous drip (I.V.) started in their arm. An I.V. is necessary with an epidural anesthesia; however, if you have chosen not to have an epidural, an I.V. is not always required. Most physicians agree an I.V. is helpful if a woman needs medications or fluids during labor. It’s also a good safety precaution for problems, such as bleeding; if a woman bleeds heavily before or during labor, medications or blood can be administered quickly. If you are concerned about having an I.V., discuss it with your healthcare provider at an office visit.

Enemas

Not every woman is required to have an enema to empty her bowels; usually you have a choice. There are benefits to having an enema in labor. It decreases the amount of fecal contamination during labor and at the time of delivery. It may also help you after delivery if you have an episiotomy because having a bowel movement very soon after delivery can be painful. Discuss any concerns you have about enemas at one of your prenatal appointments.

When a baby is born early—even by only a week or two—it may cause learning delays later in life.

When Your Healthcare Provider Isn’t Available

In some cases, when you get to the hospital, you may learn your healthcare provider is not available and someone else will deliver your baby. If your healthcare provider believes he or she might be out of town when your baby is born, ask to meet healthcare providers who “cover” when your healthcare provider is unavailable. Although your healthcare provider would like to be there for the birth of your baby, sometimes it isn’t possible.

Will I Need an Episiotomy?

An episiotomy has been one of the most commonly performed procedures in obstetrics and has almost become routine in some places. In 2000, about 33% of women giving birth vaginally had an episiotomy. However, many experts believe it’s being used less frequently now. Today, many healthcare providers let the tissue between the vagina and rectum tear naturally during childbirth.

An episiotomy is a controlled, straight, clean cut, made from the vagina toward the rectum during delivery. It’s done to help avoid tearing as baby’s head passes through the birth canal. An incision may be better than a tear or rip that could go in many directions. The cut may be made directly in the midline toward the rectum, or it may be a cut to the side. After delivery, layers are closed with absorbable sutures that don’t require removal. An episiotomy heals better than a ragged tear.

Benefits of an episiotomy for a woman include a lower risk of trauma to the area from the tailbone to the pubic bone, less relaxation of pelvic organs with prolapse, less chance of stool and/or urine incontinence, and lower likelihood of sexual dysfunction. Benefits to baby may include more rapid delivery. However, there are disadvantages to an episiotomy. Research shows it may lead to a more difficult recovery, some sexual problems and increased risk of incontinence.

Discuss an episiotomy at a prenatal visit. Ask if it is routine or if it is done only when necessary. Some situations do not require an episiotomy, such as a small or premature baby. However, your healthcare provider may not be able to make this decision until delivery.

An episiotomy is not necessary for every woman. The more children a woman has, the less likely it is she will need one; it depends on the size of the baby. Factors leading to an episiotomy include the size of the mother’s vaginal opening, the size of the baby’s head and shoulders, the number of babies previously delivered and whether this delivery is a forceps or vacuum delivery.

Episiotomies are described according to the relative depth of the incision.

1st 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, the muscle that goes around the anus.

4th degree goes through the three layers described above and the rectal mucosa.

If you have an episiotomy, after baby’s birth, epifoam may be prescribed to treat pain and itching. It comes in an applicator that provides a measured amount for each application. You may want to ask your healthcare provider about it. Other medications are also safe to use even if you breastfeed baby. Acetaminophen with codeine or other medications may be prescribed for pain.

 
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