How To Perform A Mediolateral Episiotomy
Procedure
- Check that the anaesthetic has taken sufficient effect by carefully sticking the hypodermic needle in the perineal pathway of the episiotomy.
- Using two fingers of the left hand protect the head of the foetus, whilst inserting a blade of the episiotomy scissors into the vagina [Figure 37]. Whilst performing the episiotomy, the scissors or the scalpel should be set perpendicular to the tissue.
Figure 37
- Start the episiotomy from the median line. In the case of the mediolateral episiotomy in particular, there is a tendency to glide away laterally with the scissors [Figure 38]. In general, this leads to a wound that is more difficult to suture and there is a greater risk of dyspareunia. Also, if the incision is started too laterally, there is a risk of damaging the Bartholin’s duct.
Figure 38
- Cut or incise the perineum, vagina, and the tissue in between, in the desired direction and to the desired depth. An episiotomy does not need to have a standard size, but can be performed to satisfy the desired measurements. A small episiotomy can provide an excellent result whilst at the same time causing far less damage.