PERFORMING EPISIOTOMY

REQUIREMENTS #

1. A tray containing the following:
   1. Sterile drape
   2. Sterile gown and gloves
   3. Gauze swabs and pad
2. -Needle holder
   1. Sponge holding forceps
   2. Rubber apron
   3. Episiotomy scissor
   4. Stitch scissor
   5. 10ml syringe
   6. Toothed
   7. Non toothed forceps
   8. Suture material (absorbable)
   9. 1% lignocaine
   10. Adjustable stool
   11. Antiseptic lotion
   12. Good source of light

STEPS #

1. Establish rapport to mother (Refer steps)
2. Explain procedure (Refer steps)
3. Collect and assemble all items
4. Maintain infection, prevention technique throughout the procedure
5. Wear mackintosh apron and perform hand hygiene
6. Help the woman get into lithotomy position
7. Make sure there are no known allergies to lignocaine or related drugs
8. Put on sterile gloves and infiltrate beneath the vaginal mucosa, beneath the skin of the perineum, and deeply into the perineal muscle using about 10ml 1% lignocaine
9. Make sure to aspirate (pull back on the plunger) to be sure that no vessel has been penetrated
10. Remove the needle if blood is returned in the syringe with aspiration  
11. Recheck the position carefully, try again and never inject if blood is aspirated
12. Wait 2 minutes and then pinch the incision site with forceps, if the woman feels the pinch, wait 2 more minutes and then retest
13. Place your index and middle fingers of the left hand (or non-dominant hand) into the vagina, with the palmar side facing you
14. Separate them slightly and exert outward pressure on the perineal body; while the fingers remain in between the foetal head and perineum
15. Using the right (or dominant) hand, insert the scissors with blunt end inside the vagina starting at the fourchette, turning the scissors either at 450 away from the midline (mediolateral direction) towards the left or right buttock or straight down towards the rectum (midline)
16. Make one straight cut approximately 2-3cm up the middle of the posterior vagina, OR 3-4 cm in the mediolateral direction, at the height of a contraction
17. Control baby’s head and shoulders as they deliver, ensuring that the shoulders have rotated to the midline to prevent an extension of the episiotomy
18. Carefully examine for extensions and other tears and repair