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An episiotomy is a surgical procedure in which an incision is made in the perineum, the area between the vagina and the anus, during childbirth to widen the vaginal opening and make it easier for the baby to pass through. The procedure is typically performed by an obstetrician or midwife, and is usually done when the baby’s head is crowning, or when the baby is in distress and needs to be delivered quickly.

Types of Episiotomy

The incision made during an episiotomy can be either a mediolateral or midline incision.

• A mediolateral incision is made at a 45-degree angle from the midline of the perineum, and is considered to be less likely to extend into the anus.
• A midline incision is made directly down the middle of the perineum and is thought to be more likely to extend into the anus.

Routine Episiotomy

Episiotomy is a common practice in many countries but in recent years, research has indicated that routine episiotomy may not be necessary for most women and that it may cause more harm than good. The American College of Obstetricians and Gynecologists (ACOG) now recommend that episiotomies be performed only when the baby’s head is crowning and in a difficult situation, such as when the baby’s shoulder is stuck or when a forceps or vacuum delivery is needed.

Recovery

After the episiotomy, the incision will be stitched closed. The area will be sore and swollen for a few days, but most women find that the pain can be managed with over-the-counter pain relievers and a sitz bath. It may take several weeks for the incision to heal completely.