Prevention/avoidance
The question of whether or not an episiotomy should be performed is not so easy to answer. Opponents postulate that episiotomies increase the number of perineal tears, while advocates of episiotomy argue that episiotomies prevent perineal tears. When asking whether perineal sections can be prevented or avoided, it should be noted that the most important thing is to avoid perineal tears.
If an episiotomy is probable, an episiotomy should be recommended, as the risks and benefits are clearly weighed against the benefits. The smaller a child and the larger the perineal area of the woman’s body, the less the need for an episiotomy. There are also numerous reports that forced pressing exercises during birth increase the risk of perineal tears.
From the point of view of orthodox medicine, however, a speedy birth process is very important for the safety of the child. It is also said that supine positions during birth increase the risk of perineal tears/perineal lacerations. Midwife associations recommend other body positions for the birth.
The most important measure to avoid episiotomy is a safe perineal protection, which is carried out by the midwife. Perineal protection is a holding technique carried out by the obstetrician that limits and supports the edges of the perineal muscles accordingly. This holding technique ensures that the perineum tears less frequently.
Particularly strongly trained pelvic floors tend to be more stable due to the muscular tone and tend not to make room for the born child, which greatly increases the risk of an episiotomy. However, leaving a pelvic floor untrained is not advisable in view of the consequences of childbirth (risk of incontinence). If the episiotomy is waited for too long or is deliberately avoided and the perineum tears, then this process cannot be reversed by a subsequent episiotomy.
Perineal tears should be prevented in any case. As a further preventive measure, perineal massage shortly before birth is recommended by midwife bandages to reduce the strong muscle tone. Skin oils should be used for the perineal massage.
Episiotomy inflammation
In an episiotomy, a scalpel is used to separate muscles of the perineal area in order to give the child more space during the birth process. These muscle ends are sutured again after birth and closed with a bandage. As with any wound that has to heal, there is always the possibility of inflammation that occurs after such an operation.
The risk of an inflammation of the wound in the area of the perineal muscles is rare but cannot be excluded. Infections in the area of the perineal incision usually occur after a few days. In most cases, self-dissolving suture material is used for the perineal suture.
The first signs of a wound infection are a weeping wound, reddening of the wound and pain. A gynaecologist should then immediately check the wound. It is essential to check whether the ends of the muscles have already grown together or whether there is a gap in the wound.
In this case the suture should be corrected again. In case of infection, treatment should be carried out quickly. Camomile baths are not medicated and can be used regularly.
If this is not sufficient, antibiotic treatment is necessary. In this case, a preparation should be chosen which can be used without any risk during the breastfeeding period (see also Problems during breastfeeding). One example would be Cefuroxime 500 mg 2 times daily.
