Episiotomy is a small cut in the perineum to help the baby’s head or shoulders come out. It is used in special moments, not all births. In 2025, major guidelines recommend restrictive, not routine, use.
This article explains Episiotomy in easy words. You will learn when it helps, when it does not, and how to heal well. We also show proof from trusted groups like WHO, ACOG, RCOG, NICE, and Cochrane. Use this guide to plan, ask questions, and feel ready.
Episiotomy makes space at the vaginal opening during the last part of birth. A clinician gives local anesthesia, cuts at crowning, and repairs the cut after birth. The goal is to help a safe birth when time is tight or tissue is very tight.
Most global bodies say do not do Episiotomy for every birth. “Selective” or “restrictive” use means it is done only for clear reasons. This approach lowers pain, stitches, and severe tears overall. It also respects your tissue and your choice.
The main types are midline and mediolateral (or lateral). A midline Episiotomy goes straight down from the back of the vaginal opening. It can be quick and heal neatly, but it has a higher risk of severe tears into the anal sphincter.
A mediolateral Episiotomy angles away from the anus. Many services aim for about 60° from the midline at crowning to end near 45° after the head is born. This angle lowers severe tear risk. Your team should choose the type that best protects you.
Episiotomy can help when the baby must be born fast and the perineum will not stretch in time. It can also help during a forceps or vacuum birth, or when thick scar tissue blocks stretch. It may help if the baby is very large and the tissue is very tight.
Episiotomy is also used when there is fetal distress late in the second stage. In that moment, a quick cut can shorten birth by seconds to minutes. The decision should be explained, and consent should be sought whenever possible.
Do not use Episiotomy early in labor or to speed the second stage without a clear reason. Do not do it for convenience or routine. Warm compresses, hands-on support, and patient coaching can reduce the need.
If the baby’s head and shoulders are already delivering and the tissue is stretching well, an Episiotomy adds pain and stitches without benefit. Restrictive use keeps the rate low and outcomes better for many families.
Before an Episiotomy, your clinician should numb the area with local anesthetic unless the perineum is already numb from an epidural. They should check the numbness before cutting. You should feel pressure, not sharp pain.
If there is no time for local because of severe fetal distress, the team should tell you why. They should also give support at once after the cut and during repair. Respectful communication matters as much as the technique.
After birth, the team repairs Episiotomy with absorbable sutures. They close the vagina, the muscles, and the skin in layers. A continuous, non-locking suture can lower pain later compared with many interrupted stitches.
Good repair technique helps you heal faster. It lowers bleeding and infection and reduces pain. If you feel uneven pain or swelling later, ask for a wound check. Early care can prevent bigger problems.
The main benefit of Episiotomy is space when seconds count. It can lower the chance of uncontrolled tearing in a very tight or rigid perineum, and it can make a complex assisted birth safer. In trained hands, it can be a helpful tool.
Risks include pain, bleeding, infection, and sexual pain during early recovery. A midline Episiotomy raises the risk of obstetric anal sphincter injury (OASIS). A mediolateral cut lowers that risk but can hurt more at first. Your team should explain the balance for your case.
Fetal Macrosomia means a very large baby, often 4,000–4,500 g or more. With a large baby, the perineum may be under extra stretch. Episiotomy can help if the tissue will not yield and the baby must be born quickly.
Episiotomy cannot prevent shoulder dystocia. Maneuvers, not a cut, solve a shoulder dystocia. But a mediolateral Episiotomy can create room for the clinician’s hands to perform those maneuvers. This is part of a safe plan when Fetal Macrosomia is suspected.
In operative vaginal births, a mediolateral Episiotomy can reduce severe perineal tears, especially with forceps. It also gives more room to place the instrument and guide the head. Many units favor this approach when instruments are used at the outlet or low station.
Vacuum births may need Episiotomy less often than forceps, but tight tissue or fetal distress can still make it useful. Your clinician should weigh the risks and benefits with you and act only when needed.
Warm compresses on the perineum during pushing reduce severe tears and the need for Episiotomy. Hands-on perineal support helps guide the head and slow crowning. Side-lying or semi-sitting positions can help tissues open steadily.
Antenatal perineal massage from 34–35 weeks can reduce Episiotomy rates in first births. This simple step takes a few minutes most days. Ask your team how to do it safely. Small habits add up to less cutting and smoother recoveries.
Right after the repair, you will get pads, ice, and pain control. You may feel stinging the first few days. Keep the area clean and dry. Change pads often. Take pain medicine as advised. This helps you move and feed your baby.
Most Episiotomy wounds heal well in two to three weeks. Deep tenderness can last longer, but it should improve. If pain worsens or you see pus, gaping, fever, or a bad smell, call your team. Quick care prevents bigger issues.
Sitz baths with warm water can ease pain and swelling. Stool softeners and fluids prevent straining. Hold a pad against the wound when you cough or pass stool. Gentle pelvic floor squeezes improve blood flow and aid healing.
Plan a check at 6–12 weeks. If sex is painful, ask for pelvic floor therapy. If you leak stool or gas, or feel urgency you cannot control, ask for an early review. Many issues improve with therapy, and early help matters.
You can resume sex when you feel ready and the wound has healed, often after a few weeks. Use lubricant, go slow, and talk with your partner. If pain persists, see your clinician. Pelvic floor therapy and scar care can help.
Long-term pain after Episiotomy is uncommon but real. Do not suffer in silence. A review can spot a tight stitch, a tender scar, or a pelvic floor spasm. Small treatments can make a big difference to comfort and closeness.
You can state your preference for restrictive Episiotomy in your plan. You can ask for mediolateral rather than midline if one is needed. You can ask for local anesthesia before cutting and a clear call of “cut now” so you know what is happening.
Include how you want to be told, who should be at your side, and how you want consent handled at speed. These small steps protect your voice during a fast moment. Your choices matter even when time is short.
A well-angled mediolateral Episiotomy (about 60° at crowning) lowers severe tear risk. Good hemostasis, layered closure, and continuous sutures reduce pain and bleeding. Absorbable synthetic sutures often feel better than plain gut later.
Antibiotics are not routine for a simple Episiotomy. They are recommended if there is a third- or fourth-degree tear involving the anal sphincter, or if there are signs of infection. Your team will follow local policy and explain the plan.
Many hospitals track Episiotomy rates and severe tear rates. They use drills, angle guides, and coaching to improve care. Teams review each cut, why it was done, and how the repair felt at follow-up. You can ask your unit about their rates.
This tracking shows steady progress. Restrictive policy plus warm compresses and hands-on support reduces severe tears without raising other risks. It also lowers the number of stitches and improves comfort after birth.
Does Episiotomy prevent severe tears? Not always. In some cases it may guide the tear away from the anus, but in others it can add a wound. The best protection is gentle birth, good perineal support, and a well-angled cut only when truly needed.
Will I need Episiotomy again next birth? Many people do not. A prior Episiotomy does not mean you will need another. Share your history with your team. Plan a restrictive approach and supportive practices from the start.
If your baby is suspected to be very large, talk early. Ask how your team will judge size. Ask about induction, shoulder dystocia drills, and how Episiotomy fits the plan. Make your wishes clear and keep space for fast choices if needed.
Your choices include position changes, warm compresses, and a preference for mediolateral Episiotomy only if needed. Your recovery plan can include sitz baths, pelvic floor therapy, and a check-in for sexual pain or leakage. A clear plan lowers stress and improves care.
WHO recommends against routine Episiotomy and supports a restrictive approach with warm compresses and hands-on support. This is part of respectful care and safer births worldwide. You can read the guidance on their site.
ACOG and RCOG also support selective Episiotomy. They favor mediolateral cuts when a cut is needed, especially in assisted births. NICE reviews show that perineal warm compresses and manual support reduce severe tears. Cochrane reviews back selective use and show less trauma and fewer stitches than routine cutting.
Ask three simple questions: Why do we need it now? Which type will you do and why? How will you numb and repair it? If possible, get a short consent even in fast moments. Clear words lower fear and improve trust.
After birth, ask what type and angle you had, how many stitches, and what to expect. Ask who to call if it hurts more or looks worse. Early help is the key to a smooth recovery after Episiotomy.
In a forceps birth, a mediolateral Episiotomy can lower severe tear risk and help place the blades. In a vacuum birth, it may still help if the perineum is rigid or if the baby needs to be born now. Your team should weigh this in real time and explain their choice.
In a shoulder dystocia, maneuvers free the shoulder. An Episiotomy does not fix the impaction, but it can create space for the clinician’s hands. This can speed safe steps and reduce trauma to both of you.
Use ice packs for 24–48 hours as advised. Take pain relief on schedule. Do gentle pelvic floor squeezes. Keep the wound clean and dry. Use a squeeze bottle after voiding and pat dry.
Call if you have fever, bad smell, pus, gaping, or pain that grows rather than eases. Call if you leak stool or gas or cannot control wind. You deserve fast care and comfort while you heal from Episiotomy.
Episiotomy is a tool, not a routine. Restrictive use plus good support keeps birth safer. A mediolateral cut at the right angle lowers severe tear risk. Repair with modern sutures and layers eases pain.
Your voice matters. Put your Episiotomy wishes in your plan. Ask for warm compresses and support. Ask for local before cutting. Ask for clear repair steps and follow-up. With the right plan, Episiotomy can be rare, safe, and respectful.
This guide uses current 2025 practice. It explains Episiotomy with proof, plain words, and choices you can make. Share it with your partner and your care team. Your informed voice is part of safe, respectful birth.