Episiotomy is a surgical cut that is made to the perineal skin (at the base of the vagina) during the pushing stage of labor. There are two main types of cuts. A midline episiotomy is cut straight down towards the anus. A mediolateral is cut to the side. The cut made by an episiotomy is equivalent to a second degree tear, meaning that both skin and muscle are cut. Although this procedure may be done in any birth setting, the highest rates for episiotomy are in hospital births.
In some parts of the world, episiotomy is still part of the standard birth care. In other parts, it’s use has greatly diminshed. This is because research has shown episiotomies are not helpful at preventing further tear, and do not improve healing time.
In places where episiotomy is more rare, its use is mostly dependent on the birth attendant’s decision making in the moment. In cases of fetal distress, an episiotomy may be used to shorten pushing by 5 to 15 minutes allowing for the baby to be born faster and avoiding a cesarean. If the perineum appears to be preparing to tear up towards the urethra, many atendants will do an episiotomy to ensure the tear occurs at the base of the vagina where repair and healing are easier. If the perineum is not stretching, some health care providers will recommend an episiotomy.