DEFINITION:
A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labour is called episiotomty (perineotomy).
It is performed under local anesthetic and is sutured closed after delivery.
OBJECTIVES:
• To enlarge the vaginal introitus so as to facilitate easy and safe delivery of the fetus.
• To minimize overstretching and rupture of the perineal muscles and fascia.
• To reduce the stress and strain on the fetal head.
• To shorten the second stage of labour.
INDICATIONS:
When perineal muscles are excessively rigid.
Forceps , breech, occipito-posterior or face delivery
Threatened perineal injury in primigravida.
Big baby
TIMING OF EPISIOTOMY:
Bulging thinned perineum during contraction just prior to crowning is the ideal time.
TYPES:
There are four main types of episiotomy:
Medio-lateral:
The incision is made downward and outward from the midpoint of the fourchette either to the right or left. It is directed diagonally in a straight line which runs about 2.5 cm (1 in) away from the anus (midpoint between the anus and the ischial tuberosity).
Median:
The incision commences from the centre of the fourchette and extends on the posterior side along the midline for 2.5 cm (1 in).
Lateral:
The incision starts from about 1 cm (0.4 in) away from the centre of the fourchette and extends laterally. Drawbacks include the chance of injury to the Bartholin’s duct, therefore some practitioners have strongly discouraged lateral incisions.
J-shaped:
The incision begins in the centre of the fourchette and is directed posteriorly along the midline for about 1.5 centimetres (0.59 in) and then directed downwards and outwards along the 5 or 7 o’clock position to avoid the internal and external anal sphincter. This procedure is also not widely practised.
EPISIOTOMY CARE AND RECOVERY
• Keep the cut/tear and surrounding area clean.
• After going to the toilet pour a jug of warm water over your perineum to rinse it.
• Although urinating can be painful, it can be less painful if you pee in the bath (just before getting out), or in a warm shower.
• Ask your midwife, GP or health visitor about medication to help you pass stools more easily, so you can avoid putting pressure on your stitches.
• After passing a stool be sure to wipe front to back, away from your vagina, to make sure your stitches remain clean.
• Place an ice-pack or ice-cubes, wrapped in a towel or cloth, onto the affected area, to relieve the pain
• Restart your pelvic floor exercises as soon as you can after birth. They enhance blood circulation, and aid the healing process.