An episiotomy refers to the incision made at the perineum, which is the area between the vagina and the anus, in order to enlarge the vaginal opening during labor and delivery. Occasionally, the vaginal opening cannot stretch enough to accommodate the baby's head. In such cases, an episiotomy widens the vaginal opening to aid in delivering the baby. The American College of Obstetricians and Gynecologists (ACOG) recommends that episiotomies only be conducted when they are absolutely necessary, which includes situations where the fetus is stressed (e.g. low heart rate), the fetus is stuck behind the mother’s pelvic bone (e.g. shoulder dystocia), or to prevent larger tears that may happen during vaginal delivery. A surgical incision is preferred to a severe, uncontrolled perineal tear as it is important to avoid nearby tissue damage (e.g. torsion of external and internal anal sphincters).
Once the placenta is delivered, the OBGYN may suture the lacerations of the vulva. If the individual did not receive an epidural (i.e. a type of anesthesia that numbs the individual’s sensation from the umbilicus to the upper legs) prior to labor, injection of a local anesthetic (e.g. xylocaine) into the perineum is typically required.
There are two types of episiotomies, the median and the mediolateral. The median episiotomy includes a vertical incision. This type of incision is easier to repair, but has a higher risk of extending into the anal area. The mediolateral incision, on the other hand, is done at an angle (at five or seven o’clock) and offers the best protection from an extended tear of the anal area. However, a mediolateral incision is often more painful and difficult to repair. The tissues that are incised and must later be stitched are the vaginal epithelium; the perineal skin; and the pelvic floor muscles, including the bulbocavernosus muscle and the superficial and deep transverse perineal muscles. In larger episiotomies, the ischiorectal fat may be exposed, and the external anal sphincter or levator ani may be partially cut.
REEDA refers to a scale used to assess all types of postpartum perineal trauma and healing in vaginal birth. It includes five factors associated with the healing process: hyperemia, edema, ecchymosis, discharge, and approximation of the wound edges (Redness, Edema, Ecchymosis, Discharge, Approximation, or REEDA). For each assessed item, a score ranging from 0 to 3 can be assigned by the healthcare provider, with a higher score indicating a greater level of tissue trauma and less healed wound compared to lower scores.
The interpretation of the total score on the REEDA scale reveals healed: 0; moderately healed: 1 to 5; mildly healed: 6 to 10; and not healed: 11 to 15.
Alvarenga, M. B., Francisco, A. A., de Oliveira, S. M. J. V., da Silva, F. M. B., Shimoda, G. T., & Damiani, L. P. (2015). Episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability. Revista Latino-Americana de Enfermagem, 23(1): 162–168. DOI: 10.1590/0104-1169.3633.2538
