Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Performing Episiotomy

Episiotomy is a deliberate incision of the perineum used only for a clear clinical indication, such as an urgent birth or instrumental procedure when it may facilitate safe delivery. It requires informed consent where possible, analgesia, asepsis, accurate incision, and repair.

Purpose

  • Enlarge the vaginal outlet when clinically indicated
  • Facilitate urgent birth in selected circumstances
  • Avoid uncontrolled extension when the expected benefit outweighs harm

Indications

  • Instrumental birth when required by the authorized clinician
  • Suspected fetal compromise requiring expedited birth
  • Selected complicated birth where local policy supports it

Equipment

  • Sterile episiotomy and repair set
  • Local anaesthetic and syringe as prescribed
  • Sterile gloves, antiseptic, drapes, and light
  • Suture materials and sharps container
  • Resuscitation equipment and documentation materials

Preparation

  • Prepare repair and resuscitation equipment and ensure a skilled repair provider is available.
  • Explain that the woman may ask questions or request more analgesia.

Procedure steps

  • Explain the indication, benefits, risks, alternatives, and likely sensations; obtain consent whenever the emergency permits.
  • Confirm fetal and maternal status, presentation, and the authorized clinical decision.
  • Provide privacy, analgesia or local anaesthetic as prescribed, and check effect.
  • Perform hand hygiene, use sterile gloves, prepare the perineum, and make the appropriate incision during a contraction according to policy.
  • Control the birth and inspect for extension or additional trauma.
  • Achieve haemostasis, assess the extent of injury, and arrange appropriate repair by a skilled provider.
  • Inspect the repair, count swabs and instruments, and dispose of sharps safely.
  • Provide analgesia, perineal-care and warning-sign education.
  • Escalate severe bleeding, anal sphincter or rectal injury, haematoma, or inability to repair safely.
  • Document indication, consent, anaesthetic, incision, birth, injury, repair, findings, education, and response.

Precautions

  • Do not perform routine episiotomy without a clear indication.
  • Confirm anaesthesia and consent when time allows.
  • Protect the anal sphincter and inspect for extension.
  • Escalate third- or fourth-degree injury and significant bleeding.

Aftercare

  • Monitor bleeding, pain, voiding, wound, infection, and hematoma.
  • Arrange follow-up for wound review and pelvic-floor or emotional support.

Nursing considerations

  • Maintain dignity and use trauma-informed communication.
  • Ensure correct classification and referral of perineal trauma.

Patient education

  • Teach perineal hygiene, analgesia, pelvic-floor support, warning signs, and when to return.
  • Explain expected discomfort and the need to report worsening pain, swelling, fever, or bleeding.

Documentation

  • Record indication, consent, anaesthetic, incision, extension, repair, swab count, medications, education, and follow-up.
  • Document referral or escalation.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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