Understanding Episiotomy

“I want to explain what an episiotomy is so that if the topic comes up during your birth, you already know what it means and why it is used much less often today. An episiotomy is a small cut made in the perineum, which is the area between the vagina and the rectum. Years ago, it was done routinely, but we now know from strong research that routine use does not prevent tears and does not improve outcomes. Because of that, episiotomy is no longer a standard part of childbirth and is only recommended when there is a clear medical reason.

There are a few situations where an episiotomy may help. Sometimes it is recommended if the baby needs to be delivered quickly and the tissues are not stretching fast enough. It may also be used if the baby’s heart rate shows signs of distress and we need to shorten the final moments of birth. In other cases, if the tissues appear at risk for a very deep or irregular tear, a controlled cut may reduce the severity of injury. These decisions are individualized, and I would explain the reason to you in the moment so you understand exactly why it is being considered.

Like any procedure, an episiotomy has benefits and risks. The benefit is that it can create more space quickly in an urgent situation and may reduce the chance of a more unpredictable or jagged tear. The risks include pain during recovery, bleeding, and a small chance of infection. Some women also feel discomfort when sitting or walking during the first week or two. The cut itself is made only at the peak of numbness during crowning, so many women feel pressure but not sharp pain. If you have an epidural, you usually do not feel the cut at all.

After the baby is born, I repair the episiotomy with stitches that dissolve on their own. The repair is done as soon as possible so the tissues line up well and heal smoothly. Recovery usually involves some soreness, especially when sitting, but it improves steadily with time. Ice, warm water baths, and good hygiene help you heal, and most women feel significantly better within one to two weeks. Full healing may take several weeks.

You are welcome to discuss your preferences about episiotomy with me now or at any time during labor. Some women prefer to avoid it unless absolutely necessary, and others want to understand exactly when I might recommend it. What matters is that you feel informed and comfortable with the plan. If the situation changes during birth, I will talk with you about what I am seeing and why we might consider an episiotomy, and you will be part of the decision. My goal is always to support a safe birth while respecting your preferences and keeping you fully involved in your care.”