Episiotomy is a procedure sometimes done during childbirth to make a woman's vaginal opening bigger. This make it easier to deliver the baby.

The skin between the vagina and anus is cut. This area is called the perineum.

Just before the baby is born, the obstetrician numbs the vaginal area opening and makes one of two cuts:

• A mediolateral cut is angled down away from the vagina and into the muscle.
• A midline cut is made straight down between the vagina and anus.

The cut makes the opening to the vagina bigger. The cut is stitched closed after the baby and placenta have been delivered.

Episiotomies were once routinely performed to prevent vaginal tears during delivery. Today, routine episiotomies are not recommended.

However, episiotomies may still be done if:

• The baby's head or shoulders are too big for the mother's vaginal opening
• The baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery

It may also be needed to speed the delivery process if there is concern about the baby's heart rate.

Many studies suggest this procedure has no benefit during routine childbirth.

Women who have an episiotomy have more intercourse-related pain after pregnancy, and wait longer before having sex after childbirth.

There is a chance the episiotomy can lead to a larger tear, or it may tear the muscles around the rectum. This can lead to later problems with controlling gas and sometimes stool. These problems are less likely if you do not have an episiotomy, and the skin tears naturally during childbirth.

Additional risks of an episiotomy include:

• Bleeding
• Bruising
• Incontinence
• Infection
• Swelling

An episiotomy usually heals without problems and may be easier to repair than multiple tears.

You can return to normal activities shortly after the birth.

The stitches are absorbed by the body and do not need to be removed.

Pain medication and ice can help relieve discomfort for the first day. After that, warm baths are helpful.

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA. 2005;293(17):2141-2148.

American College of Obstetricians-Gynecologists. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Practice Bulletin. 2006;71.

Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews. 2009;1:CD000081.

Cunningham FG, Leveno KJ, Bloom SL, et al. Normal labor and delivery. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 17.