HEALTH TALK ON:- EPISIOTOMY CARE

SUBJECT : - OBSTETRICS AND GYNECOLOGY

TOPIC : - EPISIOTOMY CARE

DATE : - 23/12/2019

TIME : - 11:00am

ILLUSTRATION : - FLIP CHART

PLACE : - RANI DURGAWATI HOSPITAL JABALPUR (M.P.)

GENERAL OBJECTIVE :- PATIENT HAVE SOME INFORMATION REGARDING EPISIOTOMY CARE

SPECIFIC OBJECTIVE :- AT THE END OF HEALTH TALK , PATIENT WILL BE

ABLE TO

 Define introduction of Episiotomy Care

 Explain the Definition for Episiotomy Care.
 Enumerate the methods of episiotomy care.
 Describe the Conclusion of Episiotomy care
.
TIME SPECIFIC CONTENT TEACHER ACTIVITY LEARNE EVALUATION
OBJECTIV R
E ACTIVIT
Y
3min Introduce Introduction Introduce the topic Group
about An episiotomy is an listening
Episiotomy incision in the perineum, carefully
Care which is the area between
vagina and anus. This
procedure is often
performed to help a
woman push out the baby
during childbirth. The
perineum is an area of the
body that is moist and
dark, a perfect situation for
infection or poor healing.
But by following some
simple strategies you can
reduce your risk of
infection, improve healing
time and reduce your
discomfort and pain.

10min Dealing An episiotomy is a minor Teacher is teaching. Group is Which kind of

With Pain incision made during listening method reducing
childbirth to widen the carefully pain?
1. Ask opening of the vagina.
physicia
n about Many medications are
painkille not safe for nursing
rs that mothers to use because
 may be they may pass through
able to breast milk to the
use. baby.
Talk to doctor about
safe medication
options to help manage
pain after an
episiotomy.

2. Place an
ice pack Group
on the  The perineum is the Listen
perineu area between the carefully
m when vagina and anus where and
are the episiotomy was Cleared
resting made. Can use an ice their
pack to help reduce doubts
swelling and ease the
pain. Wrap an ice pack
in a towel and place it
between legs while are
lying in bed or
reclining in a chair.
 Make sure that do not
leave the ice pack on
for more than 15
minutes at a time. Take
it off now and then to
3. Tighten prevent skin from
 buttocks getting too cold.
as sit
down.   Tightening
buttocks as sit
down will help to
pull the tissue
together in the
perineum, which
will help to prevent
it from stretching
and pulling at
stitches
 You may also find
that sitting on a
pillow or inflated
ring will reduce the
pressure and pain
4. Talk to in perineum.
doctor
about  Depending on
sitz situation, doctor
baths may recommend
that take a daily
sitz bath. Sitz baths
can help to reduce
the pain, swelling,
and bruising
around the wound
area.
 Fill a bathtub with
warm or cool
water. Warm water
increases the
 circulation and
may feel good, but
cool water can
decrease the pain a
5. Pour bit faster.
water  Sit in the bath for
over up to 20 minutes.
stitches
while
urinate  Urination can
cause stinging and
pain in wound area.
Any urine that runs
over wound may
also introduce
bacteria into
wound.
 To reduce
discomfort and
keep stitches clean,
pour water over the
area using a
squeeze bottle or
water bottle as are
urinating. After
you have finished
going to the
6. Put bathroom, squeeze
pressure a little more water
on over the area to
wound clean it off.
during
bowel  Bowel movements can
 moveme be a challenge after an
nts episiotomy. To provide
Teacher explained about reduce risk of
support during a bowel
movement, press a becoming constipation
fresh sanitary pad
against your perineum
and hold it there while
go. Doing so should
help to reduce pain and
discomfort. .
 Make sure that discard
the pad after have
7. Reduce
risk of finished and use a new
becomin one every time have to
g
constipat go.
ed   Constipation will
increase the pressure
against the perineum
during a bowel
movement. This
increased pressure
will lead to increased
discomfort and
stretching of the
incision line. To
reduce chances of
becoming
constipated, make
sure that drink plenty
of water, eat fiber
 rich foods, and get
some mild exercise
during the day.
 Drink at least eight 8-
ounce glasses of
water a day if are
bottle feeding and a
few extra if are
breastfeeding.
 Try not to get
compulsive about
drinking water
because over
hydrating can cut
milk supply. Just
don’t allow yourself
to be thirsty during
the day.
 Eat foods that are
fiber rich. Fiber rich
foods will help
loosen stool and
make it easier to have
a bowel
movement. Fruits and
vegetables are good
sources of fiber.
 Get some mild
exercise during the
day. Exercise helps
colon move food
along. Aim for 15 to
30 minutes of mild Teacher explained about the supporting
 exercise a day in the
postpartum period.
the healing process
 Talk to doctor if still
experience
constipation. Call the
doctor if these
measures do not
make a difference in
bowel habits within a
couple of days.
Doctor may
recommend a gentle
Supporting stool softener until
5min The Healing body becomes Group
Process regular again. Do not Listen How are the
take an over-the- carefully
counter stool softener and supporting the
without consulting Cleared healing process?
physician. their
doubts
 Because the wound is
between vagina and
anus, will need to
take extra care to
keep the wound as
clean and dry as
possible.
 Always rinse the
area with water after
urinating and wipe
bottom from front to
back after you have a
bowel movement.
 Doing so will help
keep the area clean
and reduce the
1. Keep the potential for infection
area from bacteria in the
clean stool.
and dry
to
encoura
ge the
stitches
to heal
 Start doing Kegel
exercises as soon as
possible after give
2. Start birth as long as
doing doctor says it is okay.
Kegel Doing Kegel
exercise exercises will help to
s improve circulation
and speed healing
time. It will also help
body to repair some
of the tissue damage
from giving birth.
 Kegel exercises
strengthen the pelvic
floor muscles that
support the bladder,
uterus, and rectum. In
addition to helping
your episiotomy
wound to heal, this
 exercise can also help
reduce urinary
incontinence in
women and
strengthen
contractions during
orgasm.
 To perform Kegel
exercises, start with
an empty bladder and
imagine trying to stop
self from urinating
and passing gas at the
same time. Are trying
to squeeze and lift the
area. Be sure that are
squeezing and lifting
without using any
other muscles. Do not
tighten stomach
muscles, squeeze legs
together, tighten
buttocks, or hold
breath. Only the
pelvic floor muscles
should be working.

 Since an episiotomy
wound does not get
much exposure to air
during normal daily
activities, it is
important to expose
 wound to air now and
then. Exposing
wound to air for a
few hours per day
3. Expose will help to reduce
the area the moisture against
to air the stitches.
 When are napping
during the day or at
night, take off
underwear so that
wound will get some
exposure to the air.

 Will need to wear a

sanitary pad while
episiotomy wound
heals. Wearing a
sanitary pad will
help to keep the
wound dry and also
prevent any blood
from getting on
underwear.
Keeping the area
4. Change clean and dry will
sanitary help it to heal
pad faster. 
every  Make sure that
two to change sanitary
four pad ever two to
hours four hours even if
it looks clean.
  Although episiotomy
wound should heal
within 10 days,
internal structures
have been stretched
and may have minor
tears in them. Most
doctors recommend
waiting six to seven
5. Talk weeks after giving
with birth before you start
doctor having sex again.
about  Ask doctor before
sex and start resuming sexual
using activity to make sure
tampon that it will be safe for
to do so.
Infections to episiotomy
wound can slow the
healing process and
increase pain. If get an
infection, will require
immediate medical
attention to reduce the
potential for serious
consequences. For the
first seven to 10 days
after episiotomy, do a
visual inspection of the
stitches and wound area
every day. Call your
doctor if notice any of
 the following symptoms:
 Increasing pain
 The wound appears
to break open
 You have discharge
with a bad odor
 You have a hard or
painful lump in the
area
 The skin between
your vagina and anus
looks redder than
usual
 The skin between
your vagina and anus
looks swollen
 You see pus coming

6. Monitor from the stitches

the area Group
for During a vaginal delivery Listen
potential the head of the baby must carefully
infection pass through the birth and
canal, through the vagina, Cleared
and out of the body.
 their
During this process the doubts
head of the baby will
usually press against the
perineum until it stretches
the tissues in this area
enough for the head to
pass through. doctor may
perform an episiotomy if:
 baby is large and
needs more room to
exit body
 baby’s shoulders get
stuck during the
delivery
 labor is so fast that
the perineum doesn’t
have time to stretch
before the baby is
ready to come out
 baby’s heart rate
indicates that the baby
is in trouble and needs

1. Ask to be delivered as fast

physicia
as possible.
n about
painkill  baby is in an
ers that abnormal position
may be
able to There are two types of
use. incisions that doctor can
make. Both types require
the same care after
delivery and at home. The
type of incision will
depend upon anatomy,
how much room is needed,
and the speed of the
delivery.
 A midline or median
incision is made from
the end of the vagina
back toward the anus.
These are the easiest
for the surgeon to
repair after the baby’s Teacher concludes about the episiotomy
birth, but they also care of the postnatal mother.
have the highest risk of
extending or tearing
back to the anus during
 the birth.
2. Learn  A mediolateral incision
about is done at an angle
the
different from the back of the
types of
vaginal opening and
episioto
my away from the anus.
This offers the best
protection against
tearing to the anus but
is more painful for the
woman after delivery.
This type of incision is
also more difficult for
the surgeon to repair
after the birth of the
child.

Let doctor know that want

to allow enough time for
the perineum to stretch on
its own during birth. Ask
for doctor’s
recommendations on how
to reduce the need for an
 episiotomy.
 Make sure that wishes
are noted in the birth
plan that the hospital
staff will follow during
the delivery. Will
either develop this plan
in doctor’s office or
3. Talk to during pre-admission.
doctor
 During labor use a
about
concern warm compress against
s
the perineum to help
the tissue to more
easily stretch during
delivery.
 Ask doctor if can stand
or squat to push. This
places more pressure
against the perineum,
helping it to stretch.
 Push for five to seven
 seconds gently while
breathing through it in
the initial stages of
pushing which slows
the delivery of the
baby and gives the
head more time to
place pressure on the
perineum and allow it
to stretch.
 Have practitioner place
gentle counter-pressure
on the perineum during
Listen
delivery so it doesn’t carefully
tear.

Can also reduce the risk of

needing to have an
episiotomy by doing Kegel
exercises throughout
pregnancy. Kegel
exercises strengthen pelvic
floor muscles and get body
ready to deliver child.
 Set aside 5-10
minutes every day to
perform Kegel exercises.

In the final six to eight

weeks before birth,
perform a perineal
massage once a day. This
will help reduce the
potential for tearing or the
need for an episiotomy
during birth. Can perform
a perineal massage alone
or with partner.
4. Do  Lie on back with head
Kegel against some pillows
exercise
s to help and knees bent.
reduce
need for  Massage a small
an amount of oil into the
episioto
my skin of the perineum.
Can use a vegetable
based oil or coconut oil
to help soften the
tissue and to help make
Define the
it stretch.
conclusions  Place fingers around
of two inches inside
episiotomy vagina and press
care. downward toward the
anus. Move finger in a
u-shape, stretching the
 skin between the
vagina and anus. May
feel a tingling or
burning sensation.
 Hold this stretch for 30
to 60 seconds and then
release. Do this stretch
two to three times

 every time do a
perineal massage.

It is imperative that
women receive high
quality evidenced based
care wherever childbirth
takes place. Practices that
reduce the adverse effects
of perineal trauma and
 make vaginal birth more
desired are to be
encouraged. Improved
perineal care may decrease
escalating interest in Listen What is the
caesarean section as an carefully conclusion?
alternative mode of
delivery.

It is imperative that
women receive high
quality evidenced based
care wherever childbirth
takes place. Practices that
reduce the adverse effects
of perineal trauma and
make vaginal birth more
desired are to be
encouraged. Improved
perineal care may decrease
escalating interest in
caesarean section as an
alternative mode of
delivery.

BIBLIOGRAPHY

 Kilatrick S, Garrison E. Normal labor and delivery. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and
Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 12.
 Rosenthal MT. Episiotomy and repair of the perineum. In: Pfenninger JL, Fowler GC. Pfenninger and Fowler's Procedures for
Primary Care. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 166.