Episiotomy is defined as a surgical incision made at the vagina to allow for passage of product of conception during delivery.
It is usually done when the product of conception if too big to pass through the birth canal.
Procedures For Episiotomy
Procedures for episiotomy include the following;
- It is a sterile procedure.
- Make sure the requirements are ready.
- Explain the procedure to the mother and obtain her consent.
- Position her in a dorsal or lithotomy position
- Perform vulva swabbing using antiseptic lotion such as hibitane 1:200
- Infiltrate the perineum with xylocaine of about 10mls. It starts to take effect in about one to two minutes.
- Insert two fingers of the left hand between the perineum and fetal head.
- Wait for the perineum to be stretched to avoid premature incision which leads to severe bleeding.
- Avoid over stretching of the perineum which may lead to delayed healing, lax pelvic muscle or vaginal or perineal tear.
- Perform incision with a sharp cut to avoid interrupted cut.
- The incision should be at the height of contraction and 2.5 cm away from the anus starting from the centre of the fourchette. The incision should not be more than 3cm long.
- Deliver the baby.
- Clean by soaking blood with pad.
- Suture the incision and make mother and baby comfortable.
- Wash, sterilize and store instruments for future use.
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Indications For Episiotomy
- Tight perineum
- Fetal distress.
- Forceps delivery.
- Button holing of the perineum.
- Slow advance of fetal head.
- During delivery of the after coming head of breech.
- Malpresentation and mal-positioning.
- Mothers with previous history of pelvic repair or surgical delivery.
- Mothers with cardiac problems.
- Mothers with respiratory disease.
- Pre-eclampsia and eclampsia.
Anatomical Structures That Are Involved In Episiotomy
- The fourchette
- The skin of the perineum
- The superficial pelvic floor muscles
- The posterior vaginal wall
Consequences of Performing Procedure Too Early
Episiotomy is a timely procedure that must be done at the right time. If it is done too early, there may be some serious consequences which include;
- Over bleeding.
- Too long incision which may affect the levator ani muscles.
- The woman will suffer double pain; that is pain of uterine contraction and pain from the incision, of which if performed at the right time, she will not be able to distinguish between the two.
- It will fail to release the presenting part.
Consequences For Performing Procedure Too Late
Just as we said earlier on, this procedure is a timely procedure and must be done at the right time, if don’t too late the following consequences may occur;
- Over stretching of the perineum leading to delayed healing, lax pelvic muscles and perineal and vaginal tear.
- There will not be enough time to infiltrate the perineum with local anaesthesia thereby causing severe pain to the mother.
Procedure For Vulva Swabbing
Vulva swabbing is an important procedure when performing episiotomy, it is usually done before the surgical incision is done.
Below are the procedures for vulva swabbing;
- Explain procedure to mother and obtain her consent.
- Get all requirements ready.
- Offer bedpan just in case she wants to void urine.
- Wash and dry your hands, don gloves and face mask.
- Provide privacy by screening.
- Protect bed linen from soiling by using drapes.
- Place patient in dorsal position with knees well flexed and apart.
- Expose the vulva area.
- Pour out antiseptic lotion.
- With the right hand pick a swab dip it into the lotion and transfer to the left without allowing both hands to touch each other.
- With the swab in the left hand, clean the labia majora farther away from you from upward to downward direction.
- With the right hand pick a swab dip it into the lotion and transfer to the left without allowing both hands to touch each other.
- With the swab in the left hand, clean the labia majora nearer to you from upward to downward direction.
- With the right hand pick a swab dip it into the lotion and transfer to the left without allowing both hands to touch each other.
- With the swab in the left hand, clean the labia minora farther away from you from upward to downward direction.
- With the right hand pick a swab dip it into the lotion and transfer to the left without allowing both hands to touch each other.
- With the swab in the left hand, clean the labia minora nearer to you from upward to downward direction.
- Repeat the whole process as often as is necessary until the vulva is clean enough.
- With your right hand which you have been using to pick the swab, pick the last swab, part the vulva with your left hand.
- Swab the vestibule, clitoris and the vaginal orifice with right hand.
- If there is excess fluid on the vulva, pick another dry swab and dry it(use about five balls of wet swab and one dry swab if need be)
- Clean the woman up.
- Dispose equipment after washing.
- Make the woman comfortable.
- Thank her for her cooperation.
We hope this information was helpful. Feel free to ask your questions in the comment section below.