Episiotomy is a procedure where the skin between the vagina and the anus (the perineum) is cut. It is done occasionally to enlarge the vaginal opening so that a baby can be more easily delivered.

Just before the baby is born, the obstetrician numbs the vaginal area 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.

An episiotomy may be needed if the baby's head is too big for the mother's vaginal opening, or the baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.

Episiotomies were once routinely performed to prevent vaginal tears during delivery. Today, there is a great deal of controversy regarding the procedure. A review of episiotomies performed in the United States found that the procedure offers no benefit, and stated there was no evidence to suggest it improves a woman's sexual function. The same review, published in the Journal of the American Medical Association, found that women who have an episiotomy have more intercourse-related pain after pregnancy and take longer to resume having sex after childbirth.

Additional risks include:

• Bleeding
• Bruising
• Incontinence
• Infection
• Swelling

An episiotomy usually heals without problems and may heal more quickly than a tear. It is also thought to help prevent vaginal stretching and to tighten the vagina after delivery. However, some women experience prolonged pain with intercourse after the procedure.

Normal activities can be resumed shortly after birth. The stitches are absorbed by the body and do not need to be removed. Pain and discomfort can be relieved with warm baths and medications.

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA. 2005 May 4;293(17):2141-8.