Is an episiotomy necessary?

An episiotomy is a deliberate cut in the perineum, the area between the vaginal opening and anus, made during birth. A clinician may discuss it if the baby needs to be born quickly, assisted birth is needed, or there is concern about a tear extending in an unsafe direction. The decision depends on what is happening at that moment, your examination, and the baby’s condition. It should not be treated as an automatic part of vaginal delivery.

Before birth, ask your maternity team when they might recommend an episiotomy and how they will involve you in the decision. During recovery, follow the wound-care instructions, keep the area clean, use comfort measures recommended by your clinician, and attend any offered review. Healing sensations can change over time, so mention ongoing pain, pulling, or difficulty with bowel movements rather than trying to judge the wound yourself.

Contact your maternity service promptly for increasing pain, spreading redness, worsening swelling, pus-like discharge, fever, a wound that appears to open, or bleeding that concerns you. Seek urgent help for heavy bleeding, faintness, severe pain, or feeling very unwell. These signs need assessment because infection, a collection of blood, or wound separation can require treatment.

Ask what specific concern would make an episiotomy useful, what alternatives may be possible, how the cut would be numbed and repaired, and which recovery symptoms should prompt a call.