Episiotomy is a surgical incision of the perineum performed to widen the vaginal opening for the delivery of an infant.

An episiotomy is made to shorten the 2nd stage of labor. Two types of episiotomy have been described, median and mediolateral.

Midline or median - refers to a vertical incision that is made from the lower opening of the vagina toward the rectum. This type of episiotomy usually heals well but may be more likely to tear and extend into the rectal area, called a third or fourth degree laceration. Advantages:

Easy to repair Encourages healing Less painful Reduced tenderness over time Less pain during intercourse Lessened blood loss Disadvantages associated with this type of episiotomy are: Increased risk of additional tearing the incision can in some cases continue to tear and may extend as far as the rectum. If the tear involves the rectum, fecal incontinence may develop; a small channel that connects the rectum and the vagina can also develop.

Mediolateral - refers to an incision that is made at a 45-degree angle from the lower opening of the vagina to either side. This type of episiotomy does not tend to tear or extend, but is associated with greater blood loss and may not heal as well. Advantage: Less chance that a tear will develop between the vagina and the rectum Disadvantages associated with this type of episiotomy are:

More blood loss More painful Harder to repair Long term discomfort Painful intercourse

Degrees of Episiotomy: First Degree - The smallest or most simple episiotomy, extending only through the vaginal mucosa. It does not involve the underlying tissues. Second Degree -This is the most common type of episiotomy. It extends through the vaginal mucosa and into the submucosal tissues, but does not involve the rectal sphincter or mucosa. Third Degree -A third degree episiotomy involves the vaginal mucosa, submucosal tissues, and a partial or complete transection of the anal sphincter muscle. Fourth Degree -The most severe type of episiotomy includes incision of the vaginal mucosa, submucosal tissues, and anal sphincter, and it also involves of the lining of the rectum. NURSING RESPONSIBILITES Assess the episiotomy site every shift to evaluate healing. Assess for any localized signs and symptoms of infection. - Signs and symptoms reflect the severity of the underlying condition Instruct the patient to cleanse from the front to the back every after voiding and defecation. Stress to patient the importance of proper hand washing specially when in contact with wound. - Hand washing is known to be a first line defense against infections. Encourage to increase fluid intake at least 8oz per hour and eat protein-rich foods such as meat and beans. - Increasing fluid intake and eating of foods rich in protein will facilitate wound healing. Administer sitz bath with warm water or moist heat after the first 24 hours after delivery per doctors order. - Reduce the local discomfort caused by perineal trauma and an episiotomy Administer anti-infectives and analgesics per doctors order. - To eradicate infection-causing microorganisms and to alleviate pain.