Episiotomy

Episiotomy is an incision made into the perineum for the purpose of enlarging the soft tissue outlet for a macrosomic (big baby) or breech fetus or to decrease the length of the second stage if the baby is in distress. Multiple reviews have demonstrated that a policy of restricted episiotomy (episiotomy only when necessary) has better maternal outcomes than a policy of routine episiotomy, with no adverse effects for the newborn.

You are not allowed to do an episiotomy but the main purpose to include the topic here is to give you an overview of what an episiotomy is, and if by chance you encounter a tight perineum which does not permit the fetal head to passes, you should refer the mother to a health centre without delay. There is no evidence that routine episiotomy results in significant reductions in laceration severity, pain, or pelvic organ prolapse compared with a policy of restricted use.

The main types of episiotomy are:

• Lateral.
• Mediolateral (commonly done).
• Median.
• J-Shaped (not commonly done).

The median episiotomy is associated with less blood loss, easier to perform and repair than the mediolateral procedure. However, median episiotomy is also associated with a higher risk of injury to the maternal anal sphincter and rectum than mediolateral episiotomies or spontaneous obstetric lacerations.

Mediolateral episiotomy is recommended for instrumental vaginal delivery. If episiotomy has to be performed, it should be done using local anaesthesia. Episiotomy and laceration repair should always be performed under adequate perineal anaesthesia.

Indications:

• When the perineum is tight and stretch no more in the second stage of labour.
• When applying forceps delivery in the second stage of labour if there is fetal distress.
• When the mother is with a heart problem, weak and unable to push in the second stage of labour.
• Preterm baby.

Contraindications:

• Extensive 3rd-degree perineal scar
  

Remember! You should NEVER attempt to do an episiotomy!.