Discussing ways to avoid an episiotomy

An episiotomy is a surgical cut made in the perineum, the tissue between the vaginal opening and anus, to enlarge the opening during birth. It may be proposed when birth needs to be expedited, during some assisted births, or when the clinician believes a controlled cut is safer in the circumstances.

The decision depends on what is happening at that moment. A preference to avoid the procedure can guide care, but an unexpected concern for the baby or a difficult assisted birth may change the balance of benefit and harm.

Record in your birth preferences that you want an episiotomy only when clinically indicated and, when time allows, after an explanation and consent. Ask whether the team supports changing positions, warm compresses on the perineum and slow, guided pushing as the baby's head is born.

Antenatal perineal massage may help you become familiar with stretching sensations and can be discussed with your midwife. During labour, listen to guidance about easing or pausing pushing near birth. No single technique can ensure that a cut will be avoided.

If an episiotomy is performed, tell your maternity team if pain is increasing rather than easing, the wound opens, discharge smells unpleasant, redness or swelling spreads, or you develop fever or difficulty passing urine. Heavy vaginal bleeding, faintness or feeling acutely unwell requires urgent care.

Ongoing pain during sex, bowel difficulty, urine leakage or pelvic heaviness also deserves follow-up. Examination can identify wound, scar or pelvic-floor problems and guide treatment.

Ask when your maternity unit recommends episiotomy, how consent is handled in an urgent situation, which birth positions are supported and what perineal care is available. You can also ask how a cut would be numbed, repaired and checked before discharge.