What Is Episiotomy and Why Is It Performed?
An episiotomy is a minor surgical cut made in the tissue between the vagina and the anus (called the perineum) during the final stage of childbirth. The aim is to widen the vaginal opening so the baby can be delivered more safely in certain difficult situations. It used to be done routinely in nearly all vaginal births, but now doctors recommend it only when medically necessary because it carries risks and may not always be better than a natural tear.
The incision is usually made when a mother is fully dilated, and it is repaired with dissolvable stitches after the baby and placenta are delivered. Most stitches absorb on their own and do not need to be removed later.
Purpose & Benefits of Episiotomy
● Helps the baby come out more quickly in certain emergency situations, such as if the baby is in distress.
● Creates a controlled cut, which may be easier for the doctor to repair than a random tear.
● May reduce the risk of severe uncontrolled tearing to the anus in some deliveries.
● Can provide more space when tools like forceps or a vacuum are needed.
● Offers clear direction and length of incision, which can make suturing simpler.
Who May Need an Episiotomy?
An episiotomy is not needed for every person giving birth. It may be recommended when:
● The baby’s heart rate suggests distress, and quick delivery is required.
● There is shoulder dystocia (baby’s shoulders stuck behind the pelvic bone).
● The mother is exhausted after a long pushing stage and needs assistance.
● A large baby may strain the perineum, and natural stretching may lead to more severe tears.
● Assisted delivery (forceps or vacuum) is needed to help the baby be born.
● The provider judges that uncontrolled tearing is more likely than a controlled cut.
Because doctors now know that routine episiotomies can cause more harm than benefit in many births, they are used less often and only in select situations.
Types of Episiotomy
Midline (Median) Episiotomy
This is a straight cut downwards from the vaginal opening towards the anus. It is often easier to repair and causes less pain later, but it has a higher risk of extending into the anal area if the tear spreads.
Mediolateral Episiotomy
This cut is made at an angle away from the anus. It reduces the risk of tearing into the anal sphincter but may be more painful and harder to repair compared with a midline cut.
Episiotomy Procedure: Step-by-Step
1. Episiotomy is usually considered when you are fully dilated and pushing, and the healthcare provider believes it will help the delivery.
2. If you do not already have an epidural or other numbing, a local anaesthetic will be given to numb the perineum.
3. During a contraction, the provider makes a small cut in the perineal tissue to enlarge the vaginal opening by either a midline or mediolateral incision.
4. The baby’s head and body are delivered through the now enlarged opening.
5. After delivery of the placenta, dissolvable stitches are used to close the episiotomy and any associated tears in the perineum.
The whole process takes place during labour and delivery and only once the provider is sure it will help safely complete the birth.
Recovery & Aftercare
After an episiotomy:
● Many people may feel soreness or pain at the incision site for several days to weeks.
● Ice packs and rest help reduce swelling; warm sitz baths can soothe discomfort.
● Pain medicine may be prescribed or recommended to manage pain during healing.
● Keep the area clean and dry, especially after urination or bowel movements.
● Stitches dissolve on their own; you usually do not need to have them removed.
● Avoid tampons or sexual intercourse until your provider says it’s safe, often around 6 weeks postpartum.
Healing can take many weeks, and discomfort gradually reduces with time and proper care.
Risks & Possible Complications
Episiotomy is generally safe, but it carries some risks, including:
● Bleeding and increased blood loss at the time of incision or afterward.
● Infection of the incision site.
● Pain and discomfort during healing and possibly during sex (dyspareunia).
● Tearing beyond the intended cut into the rectal or anal muscles (anal sphincter), which can lead to incontinence.
● Scarring and prolonged healing if the incision heals slowly.
● Rare but serious outcomes such as rectovaginal fistula or pelvic floor dysfunction in severe cases.
Natural tearing can also have complications, which is why careful decision-making and skilled repair are important.
Episiotomy vs Natural Tears
In the past, many doctors believed episiotomies would prevent large natural tears and heal more predictably. However, research now shows that routine episiotomies are not always better and may cause more pain and complications than a controlled natural tear in many cases.
Natural tears often heal on their own and do not always require an episiotomy. For this reason, episiotomies are now done only when needed rather than routinely.
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