What is an episiotomy?
The birth attendant snips the bottom of the vaginal opening to enlarge it for birth. With a midline or median episiotomy, the usual type in the U.S. and Canada, the practitioner cuts straight down toward the anus. With mediolateral episiotomy, the preferred type in other parts of the world, the cut slants off to one side. Some U.S. and Canadian caregivers routinely do mediolateral episiotomies, and some do them under certain circumstances such as for forceps deliveries.
Compared with mediolateral episiotomies, midline episiotomies are easier to repair, hurt less afterwards, cause less blood loss, cause fewer complications during healing, give better anatomical results, and are less likely to cause pain during intercourse (5). However, midline episiotomies are much more likely to extend into or through the anal sphincter (12).
Why would you need an episiotomy?
When there is fetal distress: If the baby is in trouble close to the birth, the doctor or midwife will not want to wait the additional time it may take for the birth without an episiotomy.
Judgment calls: In some cases a woman is exhausted or not stretching well, and the caregiver will recommend an episiotomy. However, unless the birth attendant rarely does episiotomies, that judgment is questionable. If exhaustion is the issue, remember that an episiotomy shortens labor by an average of nine minutes (12).
When is an episiotomy not necessary?
All of the standard reasons given for the frequent or routine use of episiotomy have been discredited by medical research (3, 6, 8, 20, 25, 26). These include: