Episiotomy sutures are used to close an incision made in the perineum, the area between the vagina and anus, during the delivery of a baby. The procedure, called an episiotomy, ideally makes the vaginal opening larger to prevent extensive tearing of tissues in the perineum. Sutures will dissolve on their own and do not need to be removed in a separate procedure. Episiotomy is controversial, since many feel it is often unnecessarily performed.
A mother may need an episiotomy procedure if the baby is particularly large or if the doctor needs to use assistive devices, such as forceps, to aid in the birth. If the baby is in distress and needs to be delivered quickly before the tissue of the perineum has had time to stretch during the pushing stage of labor, the attending practitioner may go ahead and perform the procedure. A large ragged laceration in the muscle tissue can be worse in this case than a few episiotomy sutures.
Natural tears can occur in three degrees. First degree involves only the layers of skin, a second degree tear will involve muscular tissue, and third degree tears cause damage to the rectum or anal sphincter. For deep tears, more involved closure may be needed than conventional episiotomy sutures. The degree of tearing may affect the length of recovery.
The basic procedure involves a small incision made with a pair of surgical scissors. A local anesthetic may be used, although if the area is already somewhat numbed by an epidural or prolonged labor, it may not be necessary. Once the baby has been delivered, the doctor will administer the anesthetic and put in episotomy sutures to close the wound. An interrupted mattress stitch is most commonly used.
Medicated pads and icepacks can soothe the perineum following an episiotomy and prevent swelling of the area. Sitz baths are also a good way to relieve discomfort. Pain and swelling should subside in a few days. Episiotomy sutures will dissolve by themselves within ten days, making removal unnecessary. If the skin around the sutures becomes red, swollen, or inflamed, an infection may be present and the mother should see her physician promptly.
Many childbirth practitioners do not recommend an episiotomy unless it is unavoidable. The mother may choose to try perineal massage both before and during labor in order to increase the elasticity of the area. It is important for women to discuss their feelings regarding episiotomy with their birthing practitioner. A very small incision and subsequent episiotomy sutures may be needed, in which case both mother and caregiver need to agree on what circumstances may warrant them.