Episiotomy Healing Assessment Acronym

Author:Nikol Natalia Armata

Editors:Alyssa Haag,Ian Mannarino, MD, MBA,Kelsey LaFayette, DNP, RN

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker

What is an episiotomy?

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.

Chart with REEDA across the top and scores outlined for healed to severely infected.

What is REEDA?

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.

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What does the “R” in REEDA mean?

The R in REEDA stands for Redness and evaluates the hyperemia (i.e. excessive blood supply in the vessels) around the incision of the episiotomy. The individual gets 0 points if there is no redness around the area of the incision, 1 point if the redness is within 0.25 cm of the incision bilaterally, 2 points if it extends within 0.5 cm of the incision bilaterally, and 3 points if there is redness beyond 0.5 cm. Ice packs can be applied in the area in order to decrease the redness and edema.

What does the first “E” in REEDA mean?

The first E in REEDA stands for edema. The edema, or swelling of the affected area, is caused by both topical injury of the tissues and possible inflammation in the area. The perineum, based on its location, is full of many microorganisms that may contaminate the area. Zero points are given to individuals with no visible swelling, 1 point corresponds to perineal swelling less than 1 cm from the incision, 2 points if the swelling is between 1 and 2 cm, and 3 points if the edema exceeds 2 cm and/or affects the vulvar area (e.g. vagina, labia majora, labia minora, and clitoris). Sitz baths (i.e. warm, therapeutic baths of the area around the perineum) are recommended in the early postpartum period in order to ease pain, promote healing, and assure good hygiene of the perineal area.

What does the second “E” in REEDA mean?

The second E in REEDA stands for ecchymosis (also known as bruising). Zero points are awarded for no visible bruising, 1 point if the bruises are within 0.25 cm bilaterally or 0.5 cm unilaterally of the incision, 2 points if there is bruising between 0.25 cm to 1 cm bilaterally or between 0.5 to 2 cm unilaterally, and 3 points are given if bruising is greater than 1 cm bilaterally or 2 cm unilaterally. 

What does the “D” in REEDA mean?

The letter D in REEDA stands for discharge, which exits through the incision. There can be no discharge found at the site of the incision, which corresponds to 0 points. When fluids are identified, they can either be serous fluids (i.e. body fluids resembling serum that are typically pale yellow or transparent and of a benign nature), which is awarded 1 point; serosanguinous fluids (i.e. contains or relates to both blood and the serum, creating a pinkish hue), which signifies 2 points, and lastly bloody or purulent (i.e. containing pus) fluids, which accounts for 3 points.

What does the “A” in REEDA mean?

The A in REEDA stands for approximation of the skin at the point of the incision. If the trauma is completely closed, then the individual gets 0 points. One point corresponds to skin separation of 3 mm or less. Two points are given to individuals with skin and subcutaneous fat (i.e. fat found directly under the skin) separation. Lastly, 3 points are given when the skin, subcutaneous fat, and fascial layer (i.e. fibrous tissue that surrounds muscles) are completely separated. In all episiotomies, and especially those with skin separation, stool softeners should be prescribed in order to facilitate defecation. Individuals may experience pain during sex, which should improve as the scar tissue heals. 

What are the most important facts to know about the REEDA acronym?

REEDA is an acronym used to assess episiotomy wound healing after vaginal delivery. It includes five factors associated with the healing process: redness, edema, ecchymosis, discharge, and approximation. In order to evaluate postpartum perineal trauma and healing, precise examination of the skin and muscles around the area of incision is needed. Healthcare professionals may check if the tissue is hyperemic, swollen due to injury or infections, bruised, has unusual discharge, and if the edges of the incision are well approximated.

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Related links

Anatomy clinical correlates: Female pelvis and perineum
Vaginal versus cesarean delivery: Clinical practice

Resources for research and reference

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 

Ramar, C.N., Grimes, W.R. (2021). Perineal Lacerations. In StatPearls. Retrieved from