An episiotomy is a surgical incision of the perineum made to stop ripping of the perineum with birth and to release stress on the fetal head with birth.
An episiotomy incision is formed with blunt-tipped scissors in the midline of the perineum ( a midline episiotomy ) or started in the midline but directed laterally away from the lower colon ( a mediolateral episiotomy ). Mediolateral episiotomies have got the edge over midline cuts in that if ripping happens outside the incision, it’ll be away from the lower colon, with less danger of complication from colonic mucosal tears. Nonetheless midline episiotomyies seem to heal easier, causes less blood loss, and result in less postpartum pain. Obstetric practice varies as to how frequently episiotomies are done. They were once done just when ripping appeared forthcoming, then were considered routine with a standard birth, and now are used less often.
The benefit of an episiotomy is that it substitutes a clean cut for a ragged tear, minimises force on the fetal head, and shortens the last portion of the second stage of labor. The pressure of the fetal presenting part against the perineum is so intense the nerve endings in the perineum are temporarily deadened. Therefore , an episiotomy might be done without anesthesia. Nevertheless in a number of cases a pudendal block is done ; lidocaine is injected thru a long needle thru the vaginal wall close to the ischial backbone, dulling the lower genital area and the perineum.
At the time of the incision, there’s a slight loss of blood, but the pressure of the presenting part serves to seal the cut edges and minimises bleeding. The fetal head usually edges forward significantly once the stress on the perineum is relieved.