Episiotomy degrees

Editorial Team / Admin · Jan 23, 2006

Thread moved to the OB/Midwifery forum.

mst31 · Jan 23, 2006

Ok I just did this roatation in school. Please someone correct me if I am wrong. 1st degree is just the skin, 2nd is skin and a little muscle, 3rd is skin through the muscle, 4th is all the way through the orifice. My how soon I forget after just learning this in my OB rotation! Hope this helps.

SmilingBluEyes · Jan 23, 2006

First of all, you are confusing terms.

An EPISIOTOMY is a deliberate cut into the perineal body, made by a trained care provider, to make more room, or relieve a "band" of tissue that appears to prevent the baby from being able to be delivered without apparent difficulty. Use of episiotomy techniques is considered very controversial; some doctors and midwives prefer to take a "wait and see" attitude, and let a woman deliver, tearing, possibly, believing a naturally-occuring LACERATION is better for healing, in the long run.

LACERATIONS vary by degrees as follows:

First degree: lady partsl mucosa

Second degree: lady partsl fascia and perineum

Third degree: External Anal Sphincter (partial or complete)

Fourth degree: External Anal Spincter (EAS), Internal Anal Sphincter (IAS), and rectal mucosa

Most deliveries, if handled properly, and the nurse and doctor do not stretch or manipulate the perineal body excessively, and the baby's delivery is not too rapid, the resulting tear rarely exceeds first or second degree. Sometimes, for very large babies, or rapid expulsion, you will see 3rd/4th degree tears happen. Also, you may see an "extension" to 3rd/4th degree of an episiotomy occur in some cases.

Imagine this by putting a tiny tear in a piece of paper, then putting extreme pressure on it---what happens? It tears further, along the tear line you created. This is why, among some reasons, the use of episiotomy is so controversial. Increasing numbers of doctors are now deferring episiotomy for a "wait and see" approach, which I personally, like.

Hope this helps you.

Editorial Team / Admin · Jan 23, 2006

First of all, you are confusing terms.
An EPISIOTOMY is a deliberate cut into the perineal body, made by a trained care provider, to make more room, or relieve a "band" of tissue that appears to prevent the baby from being able to be delivered without apparent difficulty. Use of episiotomy techniques is considered very controversial; some doctors and midwives prefer to take a "wait and see" attitude, and let a woman deliver, tearing, possibly, believing a naturally-occuring LACERATION is better for healing, in the long run.
LACERATIONS vary by degrees as follows:
First degree: lady partsl mucosa
Second degree: lady partsl fascia and perineum
Third degree: External Anal Sphincter (partial or complete)
Fourth degree: External Anal Spincter (EAS), Internal Anal Sphincter (IAS), and rectal mucosa
Most deliveries, if handled properly, and the nurse and doctor do not stretch or manipulate the perineal body excessively, and the baby's delivery is not too rapid, the resulting tear rarely exceeds first or second degree. Sometimes, for very large babies, or rapid expulsion, you will see 3rd/4th degree tears happen. Also, you may see an "extension" to 3rd/4th degree of an episiotomy occur in some cases.
Imagine this by putting a tiny tear in a piece of paper, then putting extreme pressure on it---what happens? It tears further, along the tear line you created. This is why, among some reasons, the use of episiotomy is so controversial. Increasing numbers of doctors are now deferring episiotomy for a "wait and see" approach, which I personally, like.
Hope this helps you.

Excellent!!

I was waiting for your very accurate explanation, Smilin'. :) Again, you are very good.

tripseven2005 · Jan 23, 2006

Thanks, that helps a lot. That makes more sense. This wasn't discussed very much in clas and isn't very clear in the book either. Thanks for all your help.