We have talked on several occasions about episiotomy, its definition, its risks and the excessive use of this surgical technique in our deliveries. Recall that an episiotomy is a surgical incision that is made to enlarge the space through which the baby must pass at the time of delivery. Today we focus on the types of episiotomy that exist.
There are two kinds of episiotomy, the medial and the mediolateral. In turn, the mediolateral can be performed to the right or to the left. A final variant of episiotomy, although sparsely practiced, is lateral.
The medial or central episiotomy
Is done vertically, longitudinally from the vagina to the anus, has the advantages that allows a greater opening of the birth canal, heals more quickly because this cut is made in an area of connective tissue, which does not have too many blood vessels. It causes less bleeding, technically it is easier to suture and usually causes less postpartum pain.
Although it is less used because it has more risks of complicating with lesions of the anal sphincter if it tears at the time of birth. This type of episiotomy is most used in North America and up to 30% in France.
Mediolateral episiotomy
Most doctors prefer the mediolateral incision, which is always kept away from the rectum and has a lower risk of tearing. The scissors section following an angle of 45º with respect to the horizontal.
The skin, some centromets of the vagina and the entire puborectal bundle of the elevating muscle of the anus are cut. It is directed obliquely towards the buttock, to the right or left depending on who practices it is right or left handed. It is the most used in Europe.
Lateral episiotomy
It is a variant of the previous one, when the angle of cut opens towards the buttock more than 45º. Sometimes the cut could be made to both sides. It protects the rectum, which is hardly laced with this type of incision, but it is not usually practiced since it affects almost all the muscles in the area and causes a more abundant blood loss than that produced with the central cut. In addition, with respect to the other types of cut, the suture usually produces more easily pains in the perineum.
