# Episiotomy

## Overview

This module describes how to perform an episiotomy, a perineal incision to widen the vaginal opening to allow passage of the foetus.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“Your baby’s head is almost out, but the opening of your vagina is small and it might tear when your baby’s head passes through. I need to make a small cut in the edge of your vagina to allow your baby to slide out more easily.”

### What can my patient expect?

“I’m going to give you an injection for pain. Then I will make a small cut with scissors while you are bearing down. It shouldn’t hurt. Afterwards I will put in stitches to repair it.”

### What is my patient’s role?

“Tell me if you have any allergies or medical conditions.”

## Preparation

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### Documentation

### Equipment

## Site & Positioning

The patient should ideally be in lithotomy or supine with their knees parted.

## Procedure

Follow medical asepsis with sterile gloves. Due to the nature of delivery, full sterility is often not possible.

## Troubleshooting

There is brisk bleeding from the episiotomy.

Pack some gauze swabs into the wound to control venous bleeding. Arterial bleeders may need to be clamped and tied off later.

I am unsure whether to prescribe antibiotics.

Prophylactic antibiotics are not routinely necessary, but may be indicated in grossly contaminated wounds.

My patient has returned with excessive pain.

Examine the perineum for the presence of a haematoma, infection, or wound dehiscence.

I have heard that midline episiotomies bleed less.

Previously, episiotomies were cut in the midline, which resulted in less bleeding but a higher risk that it might extend into a third degree tear. Mediolateral episiotomies result in more bleeding but a lower risk of third degree tear, and are currently recommended.

## Risks

## References