Episiotomy Care and Perineal

An episiotomy is a deliberate incision through the vaginal opening and perineal tissue. It is not a routine part of spontaneous vaginal birth. Current practice restricts episiotomy to selected indications determined by the birth attendant, such as an urgent need to expedite birth or a concern that an incision will facilitate a necessary operative intervention. Routine episiotomy does not reliably prevent severe tearing and can add tissue injury, pain, and risk of extension. A midline incision follows the direction of the anus and is more likely to extend into the anal sphincter complex. A mediolateral incision angles away from the midline and is associated with lower rates of obstetrical anal sphincter injury. When a mediolateral incision is used, the cut angle at crowning is generally described as near 60 degrees from the midline, although the optimal angle is not definitively established. Perineal lacerations are common after vaginal birth. Most are minor and heal without lasting functional harm, but a third- or fourth-degree injury can affect continence, pelvic floor function, comfort, and sexual activity for years. The nurse therefore assesses more...