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This video demonstrates the
use of an episiotomy to facilitate vaginal delivery of a baby.
The first free, downloadable
video shows the making of an episiotomy.
Download it now (5.7 MB).
The second free, downloadable
video shows the surgical repair of an episiotomy.
Download it now (0.9 MB).
Free Episiotomy Video
Runtime 0:24
5.7 MB mpg
Download Now
Free Episiotomy Repair Video
Runtime 2:00
0.9 MB mpg
Download Now
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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.
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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.
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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.
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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.
From OB-GYN 101:
Introductory Obstetrics & Gynecology
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