Episiotomy: When It May Be Recommended

An episiotomy is a surgical cut in the perineum, the tissue between the vaginal opening and the anus, made during birth. It is not recommended as a routine part of every vaginal birth. A clinician may suggest it when there is a specific reason to help the baby be born or reduce the risk of a more serious injury in that situation.

Ask what the procedure is intended to achieve

Possible reasons include concern about the baby or the need for an assisted vaginal birth. The decision depends on the findings at the time. Ask why the clinician recommends a cut and what the alternatives are, as the urgency allows.

Our assisted vaginal birth guide explains the related discussion about forceps or ventouse. An episiotomy is not a procedure you can determine you will definitely need from a birth story or an online checklist.

Make consent and comfort part of the conversation

The clinician should explain the procedure and seek your consent. You can record your preference for discussion in your birth plan, including how staff should communicate if events move quickly. Ask beforehand about anything that makes examinations or procedures especially difficult for you.

Local anaesthetic is normally used, or existing regional anaesthesia may be adjusted. Tell the team if you feel pain. The fact that an epidural is present does not remove the need to check that pain relief is adequate.

Understand what happens after birth

The cut is usually repaired with dissolvable stitches. The team examines the area to identify the extent of the injury, because an episiotomy can extend into a deeper tear. Ask what was found and whether it changes your recovery instructions.

The perineal tears guide explains why injuries involving the anal sphincter need a different repair and follow up plan. Ask for the details in your discharge information so you can refer to them later.

Plan practical help during healing

Soreness can make sitting, walking and toileting uncomfortable. Ask which pain relief is suitable for you and how to use it, including if you are breastfeeding. You can also ask about positions that make feeding or resting more comfortable.

Keep the area clean with water and change pads regularly. Wash your hands before and after caring for the area. If a cold pack is recommended for discomfort, wrap it rather than applying ice directly to your skin. Ask for advice about constipation or difficulty passing urine instead of straining through a problem.

Know when to request a review

Seek prompt advice for worsening pain, redness, swelling, an unpleasant discharge, fever or concern about the wound opening. Persistent pain or difficulty controlling wind or stool also needs assessment. Healing should be reviewed on the basis of symptoms, not dismissed because birth was recent.

Having an episiotomy in one birth does not automatically mean you will need another. A later pregnancy is an opportunity to review your experience and discuss the circumstances of that birth with your team.