Sometimes a doctor or midwife may ask for your consent to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy. An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.
Sometimes a woman's perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.
If your doctor or midwife feels you need an episiotomy when you're in labour, they will discuss this with you and should always gain your consent before doing anything. In England, episiotomies are not done routinely.
If you have a tear or an episiotomy, you'll probably need stitches to repair it. This is normally done using local anaesthetic in the room where you had your baby. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.
The National Institute for Health and Care Excellence (NICE) recommends that an episiotomy might be done if:
the baby is in distress and needs to be born quickly, or
there is a need for forceps or vacuum delivery (ventouse), or
there is a risk of a tear to the anus.
An episiotomy may be recommended if your baby develops a condition known as foetal distress, where the baby's heart rate gets faster or slower before birth. This means your baby may not be getting enough oxygen and must be delivered quickly to avoid the risk of birth injuries or stillbirth.
Another reason for an episiotomy is because it's necessary to widen your vagina so instruments, such as forceps or ventouse suction, can be used to help with the birth. This is called an assisted vaginal birth.
This may be necessary if:
you're having a breech birth, where the baby is being born with their bottom or feet first
you have been trying to give birth for several hours and are now tired after pushing
you have a serious health condition, such as heart disease and it's recommended that delivery should be as quick as possible to reduce further health risks.
Research shows that in some births, particularly with forceps deliveries, an episiotomy may prevent tears that affect the anal muscle (third and fourth-degree tears).
An episiotomy is usually a simple procedure. A local anaesthetic is used to numb the area around the vagina, so you do not feel any pain. If you have already had an epidural, the dose can be topped up before the cut is made.
Whenever possible, the doctor or midwife will make a small diagonal cut from the back of the vagina, directed down and out to one side. The cut is stitched together using dissolvable stitches after the birth.
Episiotomy cuts are usually repaired within an hour of your baby's birth. The cut may bleed quite a lot at first, but this should stop with pressure and stitches. Stitches should heal within one month of the birth.
It is important to keep the area clean. Only use water to wash. Wash or shower at least once a day and change sanitary pads regularly. Wash your hands both before and after going to the toilet or changing your sanitary pads. This will reduce the risk of infection.
You should drink at least two litres of water every day and eat a healthy balanced diet (fruit, vegetables, cereals, wholemeal bread and pasta). This will help your bowels open regularly and avoid constipation.
After having an episiotomy, it is normal to feel pain or soreness for two to three weeks after giving birth, particularly when walking or sitting. The stitches can irritate as healing takes place, but this is normal. Passing urine can cause stinging, pouring body-temperature water over the area when urinating can help.
Find out more about your body and recovery after birth: Your body after birth