Episiotomy

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An episiotomy is a cut made to widen the opening of the vagina. It is done toward the end of labor to keep the vaginal tissues from tearing as the baby is born. Sometimes an episiotomy can also help the doctor to deliver the baby quickly if the baby is in distress.
Who is a candidate for the procedure?

Usually, the doctor or midwife attending the birth decides whether to do an episiotomy. An episiotomy may be done when:
• the vagina cannot stretch enough to allow the baby to pass through
• a baby is thought to be large, for example, more than 9 pounds
• a forceps or vacuum must be used to help in the birth
• monitors show that the baby is in distress or not getting enough oxygen and needs to be born quickly
• the vaginal opening starts to tear as the baby's head appears
• the baby's shoulder is blocking the birth canal


How is the procedure performed?

As the crown of the baby's head pushes through the vaginal opening, an anesthetic is injected in the mother's perineum to numb it. The perineum is the skin area between the vagina and anus. A cut 2 to 3 inches long is made there. After the baby is born and the placenta is delivered, the cut is stitched up.

What happens right after the procedure?

Most episiotomies are done to prevent large vaginal tears during childbirth. These tears heal slowly, often with poor results. Widening and tearing of the vagina may cause unneeded stretching. This may later lead to problems such as:
• urinary incontinence, which is being unable to hold urine in the bladder
• a prolapsed bladder, in which the bladder sags down into the wall of the vagina
• a prolapsed rectum, in which the rectum sags down into or through the vagina
An episiotomy may help to prevent these problems.

What happens later at home?

Keeping the area clean is the key to preventing infection and to helping speed healing. The stitches will dissolve after a period of time and do not need to be removed.
To help heal an episiotomy, a woman should:
• take sitz baths or sit in a tub of warm water a few times a day. Wash the area gently with a stream of water after using the bathroom.
• relieve pain and swelling with Tucks pads and ice packs. Sitting on an inflatable donut helps, too.
• avoid constipation to keep this tender tissue from stretching too much. Take stool softeners, such as docusate, and drink 8 to 10 glasses of fluids each day.
• use over-the-counter pain relievers, such as acetaminophen or ibuprofen, as needed.
• avoid sexual intercourse for 6 weeks after the birth.
A woman should see her doctor for follow-up visits to check on how the episiotomy is healing.

What are the potential complications after the procedure?

Very rarely, an episiotomy may extend into the rectum. More stitches than usual would be required to repair the cut. The increased risks of this problem are:
• infection
• bruising
• the forming of a hole between the vagina and rectum that is called a fistula

Author:Eva Martin, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:07/09/02
Reviewer:Kathleen A. MacNaughton, RN, BSN
Date Reviewed:10/28/02
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Postpartum Depression (Baby Blues)

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Postpartum depression is a form of depression that occurs in some women within the first 6 weeks after childbirth. Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own.


What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.
Pregnancy and childbirth are accompanied by hormonal changes that can affect emotions. The round-the-clock job of caring for a new baby can seem overwhelming at times. Too little rest usually accompanies these physical and emotional stresses.

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of the following:
• certain illnesses
• certain medications, including antibiotics and medicines used to treat acne
• changes in brain chemicals
• heredity
• hormonal changes
• lack of sunlight
• major stresses
• negative thinking patterns

Risk factors for depression in general include:
• alcohol abuse
• drug abuse and addiction
• job strain
• personal history of a suicide attempt
• personal or family history of depression
• stress

The hormonal changes of pregnancy and childbirth contribute to a woman's risk for postpartum depression. Caring for a newborn can be overwhelming. Physical exhaustion, lack of sleep, unrealistic role expectations, and social isolation can all play a role in postpartum depression.

The following increase the risk for developing postpartum depression:
• early hospital discharge after childbirth
• history of severe premenstrual syndrome
• lack of support system
• marital problems
• previous history of depression
• traumatic birth experience

What are the signs and symptoms of the condition?
In general, symptoms of depression include:
• appetite problems
• decreased energy
• difficulty paying attention or making decisions
• feeling very sensitive emotionally
• feelings of irritability
• feelings of sadness, despair, and emptiness
• inability to feel pleasure
• loss of motivation and withdrawal from others
• low self-esteem
• pessimism and negativity
• sleeping problems
• thoughts about suicide and death

A woman with postpartum depression may also experience the following symptoms:
• excessive concern over the baby
• excessive, severe mood swings
• fear of harming the baby
• feelings of guilt
• frequent headaches and other physical discomforts
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