Operational Medicine Medical Education and Training


This video demonstrates the use of an episiotomy to facilitate vaginal delivery of a baby.

The first free, downloadable video shows the making of an episiotomy. Download it now (5.7 MB).

The second free, downloadable video shows the surgical repair of an episiotomy. Download it now (0.9 MB).
Free Episiotomy Video
Runtime 0:24
5.7 MB mpg
Download Now

Free Episiotomy Repair Video
Runtime 2:00
0.9 MB mpg
Download Now


 Midline and Left Mediolateral Episiotomy

Sometimes, a small incision is made in the perineum to widen the vaginal opening, reduce the risk of laceration, and speed the delivery.

There are two forms, midline and mediolateral.

A midline episiotomy is safe, and avoids major blood vessels and nerves. It heals well and quickly and is reasonably comfortable after delivery.

If the fetal head is still too big to allow for delivery without tearing, the lacerations will likely extend along the line of the episiotomy. Lacerations through the rectal sphincter and into the rectum are relatively common with this type of episiotomy.

A mediolateral episiotomy avoids the problems of tearing into the rectum by directing the forces laterally. However, these episiotomies bleed more, take longer to heal, and are generally more uncomfortable after delivery.

  • If you don't perform an episiotomy, you are increasing the risk of vulvar lacerations, but these are usually (not always) small, non-threatening lacerations that will heal well without further complications. There may not be a laceration at all.

  • If you perform a midline episiotomy, you will have fewer vulvar lacerations, but the few you have are more likely to be the trickier 3rd and 4th degree lacerations involving the anal sphincter and rectum.

  • If you perform a mediolateral episiotomy, you will avoid the 3rd and 4th degree lacerations, but you may open the ischio-rectal fossa to contamination and infection and increase the intrapartum blood loss.

From OB-GYN 101: Introductory Obstetrics & Gynecology


Home    Textbooks and Manuals    Videos    Lectures    Distance Learning    Training    Operational Safety   Supplies and Equipment    Search    About Us


This website is dedicated to the development and dissemination of medical information that may be useful to those who practice Operational Medicine. This website is privately-held and not connected to any governmental agency. The views expressed here are those of the authors, and unless otherwise noted, do not necessarily reflect the views of the Brookside Associates, Ltd., any governmental or private organizations. All writings, discussions, and publications on this website are unclassified.

2006, 2007, 2008, Medical Education Division, Brookside Associates, Ltd. All rights reserved

Other Brookside Products

Contact Us

Advertise on this Site