Wednesday, January 25, 2012


You’re going to cut my wife where? Let’s take the episiotomy one step at a time,
in a simple, less perplexing way. No pictures…I Promise!
We all know that a baby has to wiggle out of a small space during birth. This space grows
larger with each dilation of the cervix. Dilation is measured by finger-span. One centimeter dilation allows the doctor to measure with one fingertip. Two centimeters, the doctor can measure with two fingers, etc. At ten centimeters, the cervix is about the size of a grapefruit. Wow- crazy, I know. This process of dilation takes time, by once mom is at 10 centimeters,
she is complete and is ready to push.
So, what happens if 10 centimeters isn’t enough? There are gradual ways to help stretch the tissue just a bit larger. It can be done by your care provider. They can use mineral oil or even the application of a warm compress around the area and along with a gentle massage/stretch. If these methods don’t work, there may be risk for tearing of the tissue around the perineum, maybe even leading down toward the rectum. Tears often heal rather well; however, if it is a large tear, there can be severe damage.
What’s a doc to do? Well, that is up to mom. Mom may choose to try the methods above, but she could be open for a little assistance. Doctors can control a tear by cutting. This is called an episiotomy. Unlike a tear, this is a more directed cut that helps to alleviate or prevent a severe tear. You can ask your doctor to cut a little at a time, as needed. The healing of a tear can be easier than an episiotomy; however, both tears and cuts will need to be cared for and given time to mend. Please note that it is possible to get an episiotomy, but continue to tear.
Types of tears:
· Superficial-tears at the outermost layer of the vaginal tissue (no stitches required).
· 2nd Degree-deeper tears into the muscles (stitches required).
· 3rd Degree-vaginal tissue tears, perennial skin and perennial muscle tear
· 4th Degree- tears around anal area and sometimes through the anal area
How do you help your wife try to prevent tearing or the need for episiotomies? Remind
her remember to do her “Kegal” exercises. Kegal exercises decreases risk of developing hemorrhoids and leaking urine in late pregnancy. It also prepares the pelvic floor for childbirth, improves healing of the perineum from episiotomy, and can increase sexual pleasure for you and her. How does she do this? First, identify your pelvic floor muscle. One way to do this for women and men is to contract the muscle that stops the flow of urine. (Avoid doing Kegels while urinating; this can actually weaken the muscle. Only do Kegel exercises with an empty bladder). Contract the muscle and hold for 2-5 seconds, then release it, being careful not to contract the muscles in your abdomen, thighs, or buttocks). She should repeat this 10 times in a row, three times a day.
Please talk to your care provider about your wishes, before the time comes. No one wants to tear or be cut, but discussing alternative options and choices can help tremendously.

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