POSTPARTUM STRETCHMARKS & EPISIOTOMY

 

These thin scars on the stomach, hips, breasts, or butt usually start out red and then lighten within a year. "Whether you get stretch marks depends a lot on genetics and how quickly you gain weight," says David J. Goldberg, M.D., director of laser research in the department of dermatology at Mount Sinai School of Medicine, in New York City. Prescription topical ointments like tretinoin cream can , but they're not safe to use while you're nursing, and they're most effective when used soon after childbirth. Women who had a vaginal delivery often experience  (the area between the vaginal opening and anus) or  (a surgical incision through the perineum), both of which need at least six weeks to heal.

 

To help prevent a tear in the perineum, Suzanne Aceron Badillo, P.T., W.S.C, clinical program director of the Women's Health Rehabilitation Program at the Rehabilitation Institute of Chicago, suggests a daily massage of the area in the final weeks of pregnancy. A daily postpartum massage will help a scar become more pliant.

 

An episiotomy is an incision in the perineum (the area between the vagina and the anus) made just before the time of birth in order to enlarge the vaginal opening and prevent spontaneous tearing. The incision is stitched closed under local anesthesia after the baby has been delivered.

 

The number of American mothers getting episiotomies has decreased from 64 percent to 39 percent in the last 20 years. But many experts say the current figures are still too high.

 

Do You Need an Episiotomy?

There are cases where an episiotomy can be beneficial: to hasten the delivery of a baby in trouble, ease a breech birth, enlarge a too-tight vaginal opening, or prevent painful tearing toward the front of the vagina.

 

But most of the time, with local massage and control of the delivery, the vaginal tissue will stretch and then return to normal on its own. And if natural tears occur, they typically require less extensive stitching than an episiotomy.

 

A review of existing studies published in Obstetrics & Gynecology found that not only is the procedure performed too frequently, but that benefits doctors have long attributed to routine episiotomy -- including that it helps women heal faster by reducing tearing and prevents brain damage to the baby by reducing labor time -- appear not to be true.

 

What Are the Risks?

Research has long suggested that the risks of a routine episiotomy outweigh its claimed benefits. In fact, the American College of Obstetricians and Gynecologists doesn't recommend routine episiotomies. Studies show that unless the baby is in distress, an episiotomy may cause more pain and suffering for the mother than benefit for the baby. Possible problems for the mother include:

 

Tears to the anus or into the rectum, which may require surgery

Additional blood loss

Infection and swelling

Postdelivery pain

Weakness of pelvic-floor muscles

Fecal and urinary incontinence

Delayed ability to have intercourse

Avoiding an Unnecessary Episiotomy

Ask when and how often the individual doctors or midwives in your provider's group find it necessary to perform this procedure. Make sure that you're on the same page with them about when and if an episiotomy is necessary.