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Episiotomy - Overview

Definition of Episiotomy:

Episiotomy is a procedure in which the skin between the vagina and anus is cut. (This area is called the perineum.) Episiotomy is done occasionally to enlarge the vaginal opening so that a baby can be more easily delivered.

Description:

Just before the baby is born, the obstetrician numbs the vaginal area opening and makes one of two cuts:

A mediolateral cut is angled down away from the vagina and into the muscle.
A midline cut is made straight down between the vagina and anus.

The cut makes the opening to the vagina bigger. The cut is stitched closed after the baby and placenta have been delivered.

Why the Procedure Is Performed:

Episiotomies were once routinely performed to prevent vaginal tears during delivery. Today, routine episiotomies are not recommended.

However, episiotomies may still be performed when there is a complicated delivery. An episiotomy may be needed if the baby's head or shoulders are too big for the mother's vaginal opening, or the baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.

It may also be needed to speed the delivery process if there is concern about the baby's heart rate.

Episiotomy - series

Reviewed last on: 9/2/2009
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA. 2005;293(17):2141-2148.

American College of Obstetricians-Gynecologists. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Practice Bulletin. 2006;71.

Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews. 2009;1:CD000081.

Frankman EA, Wang L, Bunker CH, Lowder JL. Episiotomy in the United States: has anything changed? Am J Obstet Gynecol. 2009;200:573.e1-573.e7.

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