Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Technique for Suturing Episiotomy/Vaginal/Perineal Lacerations

Suturing repairs an episiotomy or vaginal or perineal laceration after birth. It requires accurate assessment and classification, informed consent, analgesia, asepsis, haemostasis, anatomical alignment, safe suture technique, and referral of complex injury.

Purpose

  • Restore anatomy and haemostasis
  • Promote healing and function
  • Relieve pain and prevent infection or long-term pelvic-floor complications

Indications

  • Episiotomy requiring repair
  • Vaginal or perineal laceration with bleeding, gaping, or impaired anatomy
  • Repair after inspection and classification by an appropriately skilled provider

Equipment

  • Adequate light and sterile repair set
  • Sterile gloves, drapes, antiseptic, and local or regional analgesia
  • Appropriate absorbable sutures and needle holder
  • Swabs, sharps container, urinary supplies, and emergency equipment
  • Repair, postnatal, and referral documentation

Preparation

  • Ensure skilled provider, adequate light, repair set, analgesia, sutures, counts, and referral pathway.
  • Explain each stage and protect privacy.

Procedure steps

  • Explain the injury, repair, benefits, risks, alternatives, pain relief, and possible referral; obtain consent.
  • Assess bleeding, wound extent, anal sphincter, rectal mucosa, urethra, vagina, and haematoma; classify the tear.
  • Call an experienced clinician for third- or fourth-degree injury, complex vaginal trauma, uncontrolled bleeding, or uncertainty.
  • Provide adequate analgesia and check effect; position and drape the woman with privacy.
  • Perform hand hygiene, use sterile gloves and aseptic technique, identify apex, and control bleeding.
  • Repair layers anatomically using the approved absorbable suture technique without excessive tension or dead space.
  • Check haemostasis, alignment, needle and swab counts, and rectal examination when indicated by policy.
  • Provide hygiene, analgesia, bowel, bladder, pelvic-floor, sexual-health, and follow-up education.
  • Monitor pain, bleeding, urine, wound, infection, and haematoma and arrange review.
  • Document classification, consent, analgesia, repair, material, findings, counts, education, referrals, and response.

Precautions

  • Do not repair an unclassified or complex tear without skilled assessment.
  • Exclude anal sphincter and rectal injury and refer third- or fourth-degree tears.
  • Maintain asepsis and adequate analgesia.
  • Escalate uncontrolled bleeding, haematoma, infection, urinary problems, or severe pain.

Aftercare

  • Arrange wound and pelvic-floor follow-up and review bowel, bladder, pain, and sexual health.
  • Offer emotional support after traumatic birth or repair.

Nursing considerations

  • Use trauma-informed care and never minimize perineal pain.
  • Ensure accurate referral and follow-up for major tears.

Patient education

  • Keep the area clean, take analgesia as prescribed, prevent constipation, perform pelvic-floor care, and attend review.
  • Seek help for worsening pain, fever, offensive discharge, wound opening, urinary difficulty, or heavy bleeding.

Documentation

  • Record tear classification, examination, consent, analgesia, repair technique and material, counts, haemostasis, education, and referrals.
  • Document follow-up and complications.

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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