Episiotomy: When it's needed, when it's not

Once a routine part of childbirth, an episiotomy is now recommended only in certain cases. Here's what you need to know about the risks, benefits and recovery.

By Mayo Clinic Staff

An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth. Although an episiotomy was once a routine part of childbirth, that's no longer the case.

If you're planning a vaginal delivery, here's what you need to know about episiotomy and childbirth.

The episiotomy tradition

For years, an episiotomy was thought to help prevent more extensive vaginal tears during childbirth — and heal better than a natural tear. The procedure was also thought to help preserve the muscular and connective tissue support of the pelvic floor.

Today, however, research suggests that routine episiotomies don't prevent these problems after all.

Recovery is uncomfortable, and sometimes the surgical incision is more extensive than a natural tear would have been. Infection is possible. For some women, an episiotomy causes pain during sex in the months after delivery. An extensive episiotomy might also contribute to fecal incontinence after childbirth.

The new approach


Routine episiotomies are no longer recommended. Still, the procedure is warranted in some cases.

Your health care provider might recommend an episiotomy if:

  • Extensive vaginal tearing appears likely
  • Your baby is in an abnormal position
  • Your baby is large (fetal macrosomia)
  • Your baby needs to be delivered quickly

If you need an episiotomy and you haven't had any type of anesthesia or the anesthesia has worn off, you'll likely receive an injection of a local anesthetic to numb the tissue. You shouldn't feel your health care provider making the incision or repairing it after delivery.

There are two types of episiotomy incisions:

  • Midline or median incision. A midline or median incision is done vertically. A midline incision is the easiest to repair, but has a higher risk of extending into the anal area.
  • Mediolateral incision. A mediolateral incision is done at an angle. A mediolateral incision offers the best protection from an extended tear affecting the anal area, but is often more painful and might be more difficult to repair.
July 30, 2015 See more In-depth