What is an episiotomy?

An episiotomy is a type of surgical cut that is made at the vaginal opening during childbirth. Episiotomies are usually done to help make delivery easier, instead of letting the vaginal tissue tear naturally during delivery. If your doctor is using an episiotomy, he or she will typically make the cut with scissors close to the actual time of delivery.

There are two main types of episiotomies: midline (or median) and mediolateral:

• Midline episiotomies are made in a downward direction from the vagina toward the rectum. While these are easier to repair and are usually associated with less pain and bleeding, there is an increased risk of extending into the rectum.
• Mediolateral episiotomies are made at a 45-degree angle away from the rectum. They are less likely to be associated with tears into the rectum, but they can be a bit more challenging to repair. It is common to have more bleeding, and women tend to have more pain while healing from these types of episiotomies.

Episiotomies used to be a very common during childbirth. Doctors thought the baby benefited from less time in the birth canal and that a surgical cut was preferable to natural tearing. They also believed episiotomies protected the pelvic floor muscles. Current data, however, suggests that episiotomy should no longer routinely be used as there is no benefit. Rather, doctors should only perform an episiotomy if there is a clinical need. Examples of situations where episiotomy may be useful include concerns over the baby’s heart rate (and a quick delivery is critical), the need to make more room for the baby to fit out of the vagina, and when there is a high risk of extensive tearing.

If you have concerns about receiving an episiotomy at your delivery, be sure to discuss this with your provider during your pregnancy. It is important to understand that while most providers do not perform them routinely, an emergency may arise where it is appropriate.

Reviewed by Dr. Jen Lincoln, November 2018