OBGYN Skills Lab
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OBGYN-101

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Episiotomy Video

Sometimes, a small incision is made in the perineum to widen the vaginal opening, reduce the risk of laceration, and speed the delivery.

There are two forms, midline and mediolateral.

A midline episiotomy is safe, and avoids major blood vessels and nerves. It heals well and quickly and is reasonably comfortable after delivery.

If the fetal head is still too big to allow for delivery without tearing, the lacerations will likely extend along the line of the episiotomy. Lacerations through the rectal sphincter and into the rectum are relatively common with this type of episiotomy.

A mediolateral episiotomy avoids the problems of tearing into the rectum by directing the forces laterally. However, these episiotomies bleed more, take longer to heal, and are generally more uncomfortable after delivery.

• If you don't perform an episiotomy, you are increasing the risk of vulvar lacerations, but these are usually (not always) small, non-threatening lacerations that will heal well without further complications. There may not be a laceration at all.

• If you perform a midline episiotomy, you will have fewer vulvar lacerations, but the few you have are more likely to be the trickier 3rd and 4th degree lacerations involving the anal sphincter and rectum.

• If you perform a mediolateral episiotomy, you will avoid the 3rd and 4th degree lacerations, but you may open the ischio-rectal fossa to contamination and infection and increase the intrapartum blood loss.

Click Here to watch the video.

This information is provided by The Brookside Associates,  a private organization, not affiliated with any governmental agency. The opinions presented here are those of the author and do not necessarily represent the opinions of the Brookside Associates. For educational simplicity, only one method is usually shown, but many alternative methods may give satisfactory or superior results.

This information is provided solely for educational purposes. The practice of medicine and surgery is regulated by statute and restricted to licensed professionals and those in training under supervision. Performing these procedures outside of that setting is a bad idea, is not recommended, and may be illegal.

The presence of any advertising on these pages does not constitute an endorsement of that product or service by the Brookside Associates.

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