disadvantages are that there is greater blood loss, faulty healing is more common, there
is more perineal discomfort, and they are more difficult to repair.
c. Reasons for Episiotomy. An episiotomy results in a clean surgical cut
instead of a ragged tear, it minimizes pressure on the fetal head, and shortens the
second stage of labor.
d. Repair. The obstetrician sutures the cut after delivery of the fetus and the
placenta. There is usually slight blood loss because pressure of the presenting part
constricts the cut edges and keeps bleeding to a minimum.
e. Nursing Intervention.
(1) Observe incision for signs of infection (for example, redness, swelling,
Instruct the patient to change her perineal pad each time she uses the
Teach the mother to do perineal cleansing each time she uses the
Assist the mother to use the Sitz bath as ordered.
(5) Use a perineal lamp (usually a gooseneck lamp) to improve circulation,
promote healing, and ease discomfort. The lamp should not be used too early,
otherwise bleeding may occur. Wait about 12 hours after delivery. The lamp should be
placed no less than 18 inches from the perineum. Use a 25 to 40 watt bulb. The lamp
can be used several times a day for 20-minute intervals. Drape the patient legs to
provide maximum privacy.
(6) Offer local anesthetics (nupercainal ointment, tucks, witch hazel
compresses) as ordered.
5-11. FACTS ABOUT FORCEPS DELIVERY
Forceps are used to assist in labor and delivery. Forceps delivery is considered
an operative obstetric procedure. The commonly used forceps have a cephalic curve
shaped similarly to that of the fetal head. A pelvic curve of the blades conforms to the
pelvic axis (see figure 5-3). The blades are joined by a pin, screw, or grove
arrangement. These locks prevent the forceps from compressing the fetal skull.
a. Indications for Use.
(1) Maternal. To shorten the second stage in dystocia, when the patient's
expulsive efforts (inability to push) are deficient (for example, she is tired or has been
given spinal anesthesia), and when the patient is endangered (for example, cardiac