An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.

Normally, once the baby's head is seen, your doctor will ease your baby's head and chin out of your vagina. Once the baby's head is out, the shoulders and the rest of the body follow.

Sometimes the vaginal opening may not stretch enough for the baby’s head. In certain situations, your doctor may make a small cut called an episiotomy to help deliver the baby safely.

Episiotomies are no longer done routinely. They are used only when medically needed, such as if the baby needs to be delivered quickly or if special tools like forceps or a vacuum are used.

Your doctor will decide what is safest for you and your baby..

Once you deliver the placenta, your doctor will stitch the cut. If you don't have an epidural, your doctor may inject a numbing medicine into the perineum. This will numb it before the doctor repairs the episiotomy.

Not all pregnant people need an episiotomy. Stretching the tissues naturally may help reduce your need for it. Ask your doctor about how to do this on your own. Your perineal tissues may tear without an episiotomy.

Your doctor may advise an episiotomy in these situations:

• The baby doesn't have enough oxygen (fetal distress)
• Forceps or vacuum delivery

Your doctor may have other reasons to recommend an episiotomy.

Some possible complications of an episiotomy may include:

• Bleeding
• Tearing into the rectal tissues and anal sphincter muscle that controls the passing of stool
• Swelling
• Infection
• Collection of blood in the perineal tissues
• Pain during sex
• Perineal pain
• Scarring
• Vaginal prolapse or fistulas

You may have other risks based on your condition. Be sure to discuss any concerns with your doctor before the delivery.

• Your doctor will explain the procedure and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. The form may be part of the general consent for your delivery.
• Tell your doctor if you are sensitive to or are allergic to any medicines. These include iodine, latex, tape, or anesthesia.
• Tell your doctor of all medicines (prescribed and over-the-counter), vitamins, herbs, and supplements that you are taking.
• Tell your doctor if you have a history of bleeding disorders. Or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before labor.
• Follow any other instructions your doctor gives you to get ready.

Your doctor may do an episiotomy.

Sometimes the vaginal opening may not stretch enough for the baby’s head. In certain situations, your doctor may make a small cut called an episiotomy to help deliver the baby safely.

Episiotomies are no longer done routinely. They are used only when medically needed, such as if the baby needs to be delivered quickly or if special tools like forceps or a vacuum are used.

Your doctor will decide what is safest for you and your baby.

Generally, an episiotomy follows this process:

1. You will lie on a labor bed with your feet and legs supported for the birth.
2. If you have not been given any anesthesia, your doctor will inject a local anesthetic into the perineal skin and muscle. This will numb the tissues before the incision is made. You will have no feeling from your waist down if epidural anesthesia is used. In this case, you won't need more anesthesia for the episiotomy.
3. Your doctor will use surgical scissors or a scalpel to make the episiotomy incision. This is done during the second stage of labor (pushing stage). At this time your baby's head stretches your vaginal opening,
4. Your doctor will deliver your baby followed by the placenta.
5. They will check the incision for any further tearing.
6. Your doctor will use stitches to repair the perineal tissues and muscle. The stitches will dissolve over time.

You may have pain at the incision site after an episiotomy. An ice pack may help reduce swelling and pain. Warm or cold shallow baths (sitz baths) may ease soreness and speed healing. Medicated creams or local numbing sprays may also be helpful.

You may take a pain reliever as recommended by your doctor. Be sure to take only recommended medicines.

Keep the incision clean and dry. Use the method your doctor recommends. This is important after urination and bowel movements. Stool softeners recommended by your doctor may be helpful if bowel movements are painful.

Don't douche, use tampons, or have sex until your doctor says it's okay. You may also have other limits on your activity. This includes no strenuous activity or heavy lifting.

You may go back to your normal diet unless your doctor tells you otherwise.

Your doctor will tell you when to return for further treatment or care.

Tell your doctor if you have any of the following:

• Bleeding from the episiotomy site
• Foul-smelling vaginal drainage
• Fever or chills
• Severe perineal pain

Your doctor may give you other instructions after the procedure. This will be based on your situation.

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person's qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how you will get the results
• Who to call after the test or procedure if you have questions or problems
• How much you will have to pay for the test or procedure