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An episiotomy may be needed if the baby's head is 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.
Just before the baby is born and while the woman is awake and pain-free (local anesthesia), an incision is made at the bottom of the vaginal opening to enlarge it for the delivery of the baby's head.

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