Your vagina and perineum stretch a lot during labour and childbirth so your baby can come out.
The perineum is the area between your vaginal opening and your bottom.
Sometimes your midwife or obstetrician may need to make the opening at your vagina bigger. To do this, they make a cut in your perineum. The procedure is called an episiotomy.
Episiotomies only happen in certain situations. They are more common in first-time births. Your birth team will talk to you if they feel you would benefit from an episiotomy.
You'll usually need to have an episiotomy if instruments such as a forceps or ventouse are needed during the birth. Your birth team will discuss this with you before an assisted birth.
Reasons for an episiotomy
Episiotomies are done if extra help is needed to birth the baby or to prevent the muscles and skin from tearing.
You might need an episiotomy if:
- your baby’s heart rate is beating too quickly or too slowly - this is called "fetal distress" and could be a sign that your baby is not getting enough oxygen
- your obstetrician or midwife need to make the opening at your vagina bigger - for example, if they need to use forceps or a ventouse to help with the birth
- you are having a breech birth - this means the baby is coming bottom or feet first
- your baby is big
- you have certain medical conditions and your labour needs to be as quick as possible
- you have been pushing for a while and are exhausted
- you are at risk of a third-degree tear
- there is an emergency that puts your baby at risk, such as shoulder dystocia (where their shoulders are stuck)
Third-degree tears
A third-degree tear is a tear in your perineum that also affects the muscles in your anus (bottom).
An episiotomy can reduce the risk of a third-degree tear during certain types of birth. For example, forceps births.