Mediolateral episiotomies: more astute decisions and fewer acute incisions

Abstract

Background/Aims When a mediolateral episiotomy is performed at an angle of 60° from the midline, it is associated with the lowest incidence of an obstetric anal sphincter injury. However, it has been reported that doctors and midwives believe a mediolateral episiotomy should be performed at 45o from the midline. The aim of this study was to assess doctors’ and midwives’ awareness of the optimal technique when performing a mediolateral episiotomy. Methods An interview-administered questionnaire, with an associated pictorial diagram, was completed by 78 doctors and midwives in a London maternity unit. Results Midwives reported that mediolateral episiotomy should be performed at a significantly more acute angle than doctors (45° compared with 60°, P<0.05). Doctors and midwives that had been supervised for at least 10 mediolateral episiotomy procedures were significantly more likely to be aware of (45° compared with 60°, P=0.04) and depict (50° compared with 60°, P=0.03) an optimal mediolateral episiotomy, which is performed at 60° from the midline. Conclusions Midwives and doctors that had been supervised for at least 10 mediolateral episiotomy procedures prior to independent practice knew that a mediolateral episiotomy should be performed at 60° from the midline; therefore, consideration should be given to making supervised practice mandatory, to minimise risks to pregnant people.