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When your baby’s head appears, the midwife gets your permission to make a small cut at the entrance to your vagina, so that it will be easier for you to push your baby out without tearing. Your pelvic floor area will be numbed with an injection of local anaesthetic, and the cut will be made from the bottom of the vagina, at the peak of a contraction. There are two types of episiotomy cut.
The Cut extends directly backward from the vagina, stopping short of the anus.
The cut starts off like the midline cut, but goes to one side to avoid the anus.
Not necessarily. In fact, this can be very difficult to predict, although tearing does and to be quite common with a first baby. If it seems likely that your baby’s head cannot come out easily, or that you might tear badly, your midwife will perform (with your permission) an ”episiotomy” which is small cut made with scissors as the entrance to your vagina.
It is more common to need an episiotomy if you are having your first baby, because the vaginal opening may not stretch on its own to accommodate the baby’s head. With subsequent babies, the vaginal tissues are more likely to stretch sufficiently.
There are other complications that may mean it is necessary for an episiotomy to be performed. You will need an episiotomy to be performed. You will need an episiotomy if
Unfortunately, there is no certain way to avoid having either a tear or an episiotomy. As your baby’s head stretches the outlet of the birth canal, the natural reaction is to tense the muscles of the pelvic floor, when what you really need to do is to relax them. The pelvic floor exercise help you relax the muscles of the pelvic floor during labor. You may find that giving your body time to stretch can help try to push down for as long as possible so that the perineal area is encouraged to stretch. However, if you have an epidural, do not push down too hard as the baby’s head is delivered. A warm flannel placed on the perineal area between the vagina and the anus during labor can help this area to stretch more easily. Massaging the area during pregnancy with oils or creams(particularly vitamin E creams) may also help it to become more supple.
There are different degrees of tearing most are not serious. It is more common to tear backwards, towards your back passage. Tearing towards the front is very painful, and is more likely to happen if you deliver i the all fours position, because the pressure is more towards your labia or clitoris. If you have what is called a second- degree tear, this involves the skin as well as the muscles of the vagina, and those that lie beneath. Rarely, a tear may involve the muscles or lining of the back passage, which is known as a third degree tear. This will need to be repaired by a senior doctor, sometimes under a general anaesthetic.
This obviously depends on the circumstances of the birth, and whether or not the midwife or doctor supervising the delivery is happy with this. If the birth is progressing normally, with no complications, there is no reason why your partner cannot assist in lifting the baby out, as long as your midwife or doctor agrees.
This depends on the methods of the doctor or obstetrician present, but the cord is usually clamped straight away. However, there is also a school of thought that believes that your baby can benefit from the blood and oxygen he or she receives from the placenta during the first ten minutes after the delivery, and that the cord should be left intact until it stops pulsating. The cord is then clamped and you or your partner can enjoy the ritual of cutting the cord if you want to. If you do not wish the cord to be cut immediately, you should state this in your birth plan and discuss it with your midwife or doctor. Your baby’s umbilical cord stump will drop off about ten days after the birth.
As soon as your baby’s head is born, the midwife will check to see whether the cord is around the neck because this is quite common. If the cord has wound round just once, the midwife can slip it over your baby’s head, which can sometimes cause a slightly bloodshot eye. If the cord is wound round more then once, or if it feels tight, the midwife will clamp and cut the cord immediately, to ensure that your baby can come through without restriction and to prevent the placenta from being pulled away from the wall of the womb.
Immediately after your baby is born, the doctor or midwife will examine your baby and use the Apgar score to assess his or her condition. If there are no problems, and your baby is breathing properly, he or she will be handed to you at once. However, if your baby is not breathing satisfactorily, he or she will be treated immediately with the resuscitation equipment at hand. A paediatrician will be called to check your baby over, and you and your partner will be kept informed of your baby’s condtion.
Tearing is a hazard of giving birth, most tears are minor and heal easily, but if your midwife thinks that tearing will be severe, she may feel that an episiotomy is necessary and ask you for permission to perform one.
The subject of episiotomy is still controversial. Many women fear that this procedure is still treated as a ”routine” aid to getting the baby’s head out, rather than as an ”emergency” procedure when there are genuine complications. Those in favour of episiotomy argue that it prevents the vaginal entrance from overstretching, and that it is much easier and neater to stitch a cut back together than an uneven tear. However, supporters of natural birth argue that if you are left to tear naturally and only have a minor tear, then you may not need stitching at all, and that tears heal better and faster.
Unless there are complications in the labor, you should be able to choose whether or not you are prepared to have an episiotomy. A good midwife will always try to avoid having to perform one unless absolutely necessary although many first-time mothers will be encouraged to have one if the perineum is not stretching easily. If you are strongly opposed to this, include your wishes in your birth plan, and tell your midwife. If medical staff still insist that an episiotomy is necessary, there is obviously a good reason for one, and it is advisable to follow their advice.
Where the baby is in the breech position and where an assisted delivery is necessary, whether by forceps or ventouse vacuum cup, an episiotomy is essential, and will have to be carried out.