Episiotomy: when and why is it performed?
Once routine, episiotomy is no longer performed by default — here's when it's still medically justified today.
An episiotomy is a small incision made in the perineum (the area between the vagina and the anus) just before the baby's head is born, to widen the vaginal opening. It used to be done routinely, but evidence shows a natural tear often heals just as well, or even better.
Major obstetric organizations now recommend a 'restrictive' approach — using it only in specific situations, such as fetal distress requiring a quick delivery, the need for forceps or a vacuum, or when the perineum appears about to tear in a more extensive or complicated way.
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The incision is made under local anesthesia (or while an epidural is already working) and closed with dissolvable stitches after birth. Healing generally takes 2 to 4 weeks, with discomfort gradually easing.
Steps such as perineal massage late in pregnancy, unhurried rather than directed pushing, and warm compresses during pushing can reduce the need for an episiotomy. Feel free to discuss your preferences on this with your care team before the birth.
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This information is general and does not replace advice from your healthcare professional (doctor, midwife, nurse, pharmacist). Every situation is unique: always check with them before making a decision. In an emergency, call 911 or your local emergency services.
