EPISIOTOMY & MIDWIFE CARE

Indication for episiotomy reduction of trauma shortening the second stage of labora recommended in the event of fetal distress shoulder dystocia “soft-tissue dystocia” Before forceps application, Vacuum (operative delivery) if a significant spontaneous laceration appears Breech delivery Non reassuring CTG Indication for episiotomy reduction of trauma to the fetal head, particularly in vulnerable premature infants. Another proposed advantage is shortening the second stage of labor, thereby providing respite for mother and baby from the exhaustive work of delivery. It is presumed that a shorter second stage will result in less infant hypoxia, less sepsis, and less maternal infection as well as the de facto benefit of “getting it over with.” Another argument in favor of episiotomy is concern over integrity of the pelvic floor. Prolonged labors and large infants are known to be risk factors for subsequent disorders of pelvic floor anatomy and function. By providing greater outlet dispensability without stretching, it is felt that innervation and anatomic relationships might be better preserved. Episiotomy is often recommended in the event of fetal distress and shoulder dystocia to deliver the infant more rapidly. The term “soft-tissue dystocia” was coined to encompass the notion that the perineal body may impede labor progress to a measurable and on occasion detrimental degree. Relief of this dystocia by episiotomy allows for prompt delivery of the infant. Lastly, episiotomy is considered to be indicated if a significant spontaneous laceration appears otherwise unavoidable, which includes most cases in which forceps are used. Some include use of a vacuum extractor as carrying higher potential for laceration, and would consider an episiotomy to be of benefit. One of the common exhortations of residents in the mid-1980s was “a cut is faster to repair than a tear!” Each of these indications has some indirect evidence in support of its value. In the studies cited in the next section, each has been considered as an “indicated” use of episiotomy, in contradistinction to the procedure's “routine” use. It bears comment, however, that no single indication has had the support of a prospective, randomized controlled trial with regard to measurable change in outcome based on providing or withholding the intervention.

Shoulder dystocia

Before forceps application

When you should do episiotomy ??? Just at crowning

Types of episiotomy

What midwife need to do during cutting

steps

Possible Complications of an Episiotomy An episiotomy can cause Pain bleeding Swelling bruising get infected. It can also extends into the rectum or the episiotomy wound isn’t sewn back together well.

To reduce the need for an episiotomy During labor use a warm compress to the perineum. Ask the woman to stand or squat to push. Do Kegel Exercises to Help Reduce an episiotomy a Perineal Massage

How to Care for an Episiotomy An episiotomy takes about 4—6 weeks to heal depending on the size of the incision, material used for the stitches and the lifestyle of the mother after delivery. By the time the stitches are absorbed, the skin is strong and the edges should not separate. Mother need to check her episiotomy with a mirror to make sure the skin is still closed and looks healed.

The following tips can help relieve pain and discomfort 1. Cold therapy—using ice packs Don’t apply the ice directly to the skin. Ice should be applied 20 minutes on and 10 minutes off several times a day. 2. A warm bath or sitting in a tub of warm water for 20 minutes several times a day can help relieve pain. 3. Expose the stitches to the air at least twice everyday for 10 minutes or so 4. Antibiotic for healing

call your doctor If you have any signs of infection such as fever and chills, redness, pain or swelling at the incision site you have a foul-smelling discharge or bleeding from the episiotomy site If your pain isn’t controlled with the medicines your doctor prescribes If you have problems controlling your bowels or bladder that does not go away.

Thank you for listening! 