Episiotomy

Saraswati College of Nursing Udaipur.
RJ
LESSON PLAN ON
EPISIOTOMY
SUBMITTED TO : Mr. C.G Goswami
SUBMITTED BY: Shabnam Amin, M.Sc. Nursing I year

IDENTIFICATION DATA
NAME OF STUDENT TEACHER : SHABNAM AMIN

SUBJECT : Nursing Education
TOPIC : EPISIOTOMY
GROUP : GNM3 year Students

NO. OF STUDENTS : 40 students
DURATION : 45 Minutes
VENUE : PIMS , GNM Class room
Dated : 12/08/23
METHOD OF TEACHING: Lecture cum discussion teaching method

A.V Aids : PPT & Black Board, Flash cards, Charts, Pamphlet etc.
PREVIOUS KNOWLEDGE: The students may have some knowledge regarding episiotomy .
General objectives:
The student will acquire adequate knowledge about episiotomy, gives the desirable
attitude and develops the skill in doing episiotomy for the patients in all the clinical
settings.
Specific objective: The student will be able to,
 DEFINE EPISIOTOMY
 ENLIST THE PURPOSES OF EPISIOTOMY
 ENUMERATE THE PRINCIPLES OF EPISIOTOMY
 DESCRIBE THE INDICATION FOR EPISIOTOMY
 ILLUSTRATE THE TIMING OF EPISIOTOMY
 BRIEF ABOUT TYPES OF EPISIOTOMY
 LIST OUT THE ARTICLES NEEDED FOR EPISIOTOMY
 EXPLAIN THE PROCEDURE OF EPISIOTOMY AND AFTER CARE.

S.NO SPECIFIC TIME AV AIDS TEACHER’s & EVALUATION
OBJECTIVE CONTENT LEARNER’s
ACTIVITY
EPISIOTOMY Roller board Defining
1 Define 1 min DEFINITION: Listening What is
episiotomy A surgically planned incision on the perineum and episiotomy?
posterior vaginal wall during the second stage of labor is

called episiotomy. D.C.DUTTA
2 Enlist the 2 min Pamphlet Enlisting What are

PURPOSE:
purposes of  To aid the delivery of the presenting part when and taking notes the purposes
episiotomy the perineum is tight and causing poor progress in of
the second stage of the labor. episiotomy?
 To prevent perineum from tearing.

 To allow space for operative or manipulative deliveries
(forceps and breech deliveries)
 To shorten the second stage of labor, in case of
fetal distress.
 To reduce pressure on the fetal head when delivering
a preterm infant.
 To reduce prolonged maternal pushing efforts in case
of severe hypertensive or cardiac disease.
3
Enumerate 1 min Handout Enumerating
PRINCIPLES:
the  The apex of the episiotomy must be visualized and start Asking doubts Write the
principles of
episiotomy?
principles suturing from the apex.
of  Dead space must be closed.

 Tissues must be brought together but not
episiotomy
strangulated by excessive tension on the sutures.
 Homeostasis must be obtained.
 The needles must be handled with a pair of forceps and
not by hand, should be removed from the operating
field as soon as possible.
4 1 min INDICATION: Bulletin Describing What are the

Describe
 Large sized babies board Listening indications for
the
 Preterm or small for gestational age baby episiotomy?
indication  Anticipation of shoulder dystocia
for  Fetal malpresentation and malposition.
episiotomy  Thick perineum which is rigid and resistant to
distension.
 Prior to any assisted delivery such as forceps/venous
 To speed up delivery if there is fetal distress.
5 Illustrate
the 1 min TIMING OF EPISIOTOMY: Black board Illustrating Which is the
timing Bulging thinned perineum during contraction just prior Listening time for
of to crowning is the ideal time. episiotomy?
episiotomy
TYPES IN EPISIOTOMY:
6 Brief about 2 min Median: The incision commences from the center of the Black board Explaining What are the
fourchette and extends posteriorly along the midline for types of
types of
about 2.5cm. Taking notes episiotomy?
episiotomy
Lateral: The incision starts from about 1cm away from the
fourchette and extends laterally. It has got many drawbacks
including chance of injury to the Bartholin’s duct.
Mediolateral: The incision is made downward and

outward from the midpoint of the fourchette to either the right
or the left. It is directed diagonally in the straight line which
runs about 2.5 cm away from the anus.
J-shaped: the incision begins in the center of the fourchette

and is direct posteriorly along the midline for about 1.5cm and
then direct downward and outward long 5 or 7 o’clock
position to avoid the anal sphincter. Apposition is not perfect
and the repaired wound tends to be puckered.
PREPARATION OF THE MOTHER:

 Provide privacy, adequate lightening.
 Explain the procedure to patient.
 Empty the bladder if needed
 Encourage the mother to bear down.
7 List out the 1min ARTICLES NEEDED: Bulletin Listing out What are the
A Sterile tray containing: board Listening articles needed for
articles
▣ Episiotomy scissor episiotomy?
needed for
▣ Sponge holding forceps
episiotomy ▣ Bowl with antiseptic solution
▣ Sims speculum
▣ Needle holder
▣ Toothed thumb forceps
▣ Straight scissor
▣ Gauze pad
▣ Suture material
▣ Syringe with inj. Xyloidine 2%
▣ Kidney tray
8 Explain the 5 min PROCEDURE OF EPISIOTOMY: Power point Explaining What is procedure
 Prefer the site of infiltration; insert and direct needle presentation for episiotomy?
procedure
beneath the skin at an angle of approximately 45º Taking notes.
of
for about 4-5 cm in the same line for a mediolateral
episiotomy episiotomy.
and after  Withdraw the piston of the syringe to ensure needle has
care. not entered the blood vessel.
 Infiltrate the perineum continuously as the needle is
slowly withdrawn.
 Place two fingers in the vagina between the presenting
part and the posterior vaginal wall pointing downward,
 Give a episiotomy (a single deliberate cut) during the
peak of uterine contraction when the birth is
imminent.
 Encourage the mother to bear down when there is
good uterine contraction.
 Give perineal support with right hand and urethral
support with left and exert pressure over the
occiput.
 Apply pressure with gauze pad in the episiotomy
between contractions with a sterile gauze pad if there is
delay in delivery.
 After delivery of baby, clean the perineum with
antiseptic solution and drape with central hole
towel.
 Inspect for any laceration, parauretheral tear,
cervical laceration.
 Infiltrate with inj.xylocaine 2% in perineum.
 Place the needle in the catgut in the tip of the
needle holder and hold the needle holder correctly.
 Suturing is done by vaginal epithelium, muscle and skin
layer by continuous suturing.
 After suturing perineum and rectum is examined for
any abnormalities.
AFTER CARE:
 Place the sterile pad in genital area.
 Position the mother in the supine position with
cross legs.
 Clean and replace all the articles and instruments.
 Record the time and type of episiotomy.
 Check for any bleeding or hematoma.
SUMMARY:
In this class we have discussed about definition of episiotomy, purposes, indication, principles, timing, articles needed, types and
procedure with after care.
CONCLUSION:
The students are able to learn about episiotomy, types and procedure in detail and they will implement in their practical activities in
all clinical settings.
BIBLIOGRAPHY:
 Manual of nursing procedures and practice, second edition, published by Wolters Kluwer pvt. Ltd., New Delhi. Page no: 847
to 853.
 D.C DUTTA text book of obstetrical nursing 7th edition pg.no:647-6

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Saraswati College of Nursing Udaipur.

SUBMITTED TO : Mr. C.G Goswami

SUBMITTED BY: Shabnam Amin, M.Sc. Nursing I year

NAME OF STUDENT TEACHER : SHABNAM AMIN

GROUP : GNM3 year Students

METHOD OF TEACHING: Lecture cum discussion teaching method

Specific objective: The student will be able to,

 ENLIST THE PURPOSES OF EPISIOTOMY

 ENUMERATE THE PRINCIPLES OF EPISIOTOMY

 DESCRIBE THE INDICATION FOR EPISIOTOMY

 ILLUSTRATE THE TIMING OF EPISIOTOMY

 BRIEF ABOUT TYPES OF EPISIOTOMY

 LIST OUT THE ARTICLES NEEDED FOR EPISIOTOMY

 EXPLAIN THE PROCEDURE OF EPISIOTOMY AND AFTER CARE.

episiotomy A surgically planned incision on the perineum and episiotomy?

posterior vaginal wall during the second stage of labor is

2 Enlist the 2 min Pamphlet Enlisting What are

the second stage of the labor. episiotomy?

 To prevent perineum from tearing.

of  Dead space must be closed.

4 1 min INDICATION: Bulletin Describing What are the

Mediolateral: The incision is made downward and

J-shaped: the incision begins in the center of the fourchette

PREPARATION OF THE MOTHER:

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