Last updated: January 2026
An episiotomy is a surgical cut made in the perineum (the area between the vagina and anus) to widen the vaginal opening during delivery. While once routine, episiotomies are now only recommended in specific medical situations. Here's what every expecting parent should know.
What Is an Episiotomy?
An episiotomy is an incision your doctor or midwife makes in the perineum during childbirth to help speed delivery. After your baby is born, the cut is stitched closed. It sounds intense (and honestly, it is), but there are legitimate medical reasons why it's sometimes necessary.
When Is an Episiotomy Actually Needed?
Modern medical guidelines recommend episiotomies only in specific situations:
- Breech birth complications requiring immediate delivery
- Prolonged pushing (typically after 2-3 hours with no progress)
- Assisted delivery using forceps or vacuum extraction
- Fetal distress when your baby's heart rate becomes dangerously high or low
In these cases, getting your baby out quickly becomes the priority, and an episiotomy can make that happen.
The Truth About Routine Episiotomies
Here's where things get interesting. Doctors used to perform episiotomies routinely, even during normal, uncomplicated deliveries. The thinking was that a clean surgical cut would:
- Heal better than natural tears
- Prevent severe vaginal tearing
- Reduce pelvic floor problems like bladder prolapse or rectal issues
The problem? Current medical evidence doesn't support these claims. Multiple studies, including systematic reviews by the American College of Obstetricians and Gynecologists (ACOG), show that routine episiotomies don't prevent severe tears or reduce long-term pelvic floor problems. In fact, they can sometimes cause more complications than natural tearing.
How to Reduce Your Risk of Needing One
While you can't completely control what happens during delivery, research suggests these strategies may help:
Perineal massage during pregnancy: Studies show this is most effective for first-time mothers. Start around 35 weeks and massage for 5-10 minutes daily using a natural oil. It won't guarantee anything, but it may increase tissue elasticity.
Warm compresses during labor: Applying warm, moist compresses to the perineum during the pushing stage may help soften tissues and reduce tearing risk.
Perineal massage during labor: Some healthcare providers massage the area as labor progresses to help prepare the tissue.
Choose your provider carefully: Research shows midwives perform fewer episiotomies than physicians, and newer doctors tend to follow current evidence-based guidelines more closely. Interestingly, episiotomy rates are also higher during the day (possibly due to scheduling pressures).
Try different pushing positions: Upright or side-lying positions may reduce perineal stress compared to the traditional flat-on-your-back position.
Talk to Your Provider Before Labor
The single most important thing you can do is have an honest conversation with your healthcare provider during pregnancy. Ask:
- What's your episiotomy rate?
- Under what circumstances do you perform them?
- What alternatives do you try first?
- How do you support perineal protection during delivery?
These questions will help you feel more prepared and give you realistic expectations about what to expect during delivery.
Healing and Recovery
Whether you have an episiotomy or a natural tear, recovery takes time. You'll likely experience:
- Pain and tenderness for several weeks
- Discomfort sitting or walking
- Sensitivity during urination
Use ice packs, take pain relievers as prescribed, keep the area clean, and give yourself grace. Your body just did something incredible.
The Bottom Line
Go into labor with an open mind. Birth is unpredictable, and sometimes decisions need to be made quickly for your safety and your baby's. But you deserve to understand your options and have a provider who respects evidence-based care.
If you're facing an episiotomy during labor, it's because there's a genuine medical need. Trust your team, but also trust yourself to ask questions and advocate for the birth experience you want.
Also check out: Postpartum Bleeding and Blood Clots (Fun or what?!)
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